Abstract

Introduction. Submucosal tumors (SMT) are not uncommonly found during upper endoscopy. Management for small SMT originating from muscularis propria (MP) is controversial. Data regarding regular endoscopic ultrasound (EUS) surveillance is scarce. We report our experience in using EUS to monitor these tumors.

Methods.
 Patients with SMT originated from MP as confirmed by EUS were recruited. The maximal diameter, echopattern, presence of cystic spaces and regularity of extra-luminal margin were documented. Patients with large tumors (maximal diameter > 3 cm), heterogeneous echopattern, presence of cystic spaces or irregular extra-luminal margin were offered surgery in view of malignant risk. Patients with small tumor and benign EUS features were offered regular EUS surveillance or surgery if they wished. The progress of those patients who underwent EUS surveillance were studied.

Results.
 From January 2002 to December 2007, there were 93 patients with SMT originating  from MP. Forty-nine patients had a small tumor and benign EUS features. Only two of these patients chose surgery. The histopathological results were low risk gastrointestinal stromal tumor (GIST) in both patients. Twenty-three patients elected to undergo regular EUS surveillance for a mean period of 17.3 months (range 6 - 42 months). Three patients (13.0%) showed interval increase in tumor size. There was no change in other EUS features. Surgery was performed in these 3 patients. Histological examination revealed schwannoma in 2 patients and low risk GIST in 1 patient.

Conclusion.
 It remains unclear whether EUS surveillance for small tumors originating from MP in the upper gastrointestinal tract is useful.

Keywords

Endosonographic, endoscopic ultrasound, surveillance, muscularis propria, GIST