Diagnostic procedures for submucosal tumors in the gastrointestinal tract

Abstract

This review is part one of three, which will present an update on diagnostic procedures for gastrointestinal (GI) submucosal tumors (SMTs). Part two identifies the classification and part three the therapeutic methods regarding GI SMTs. Submucosal tumors are typically asymptomatic and therefore encountered incidentally. Advances in diagnostic tools for gastrointestinal submucosal tumors have emerged over the past decade. The aim of this paper is to provide the readers with guidelines for the use of diagnostic procedures, when a submucosal tumor is suspected. Literature searches were performed to find information on diagnostics for gastrointestinal submucosal tumors. Based on the searches, the optimal diagnostic procedures and specific features of the submucosal tumors could be outlined. Standard endoscopy, capsule endoscopy and push-and-pull enteroscopy (PPE) together with barium contrast X-ray do not alone provide sufficient information, when examining submucosal tumors. Endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI) and fluorodeoxyglucose-labeled positron emission tomography (FDG-PET) are recommended as supplementary tools.

Figure 1

Endoscopic ultrasonography imagines of normal wall and submucosal tumors of the large intestine are presented. A: The normal wall displayed in 5 layers; B: Lipoma imagine showing a hyperechoic homogeneous mass located in the third layer; C: Leiomyoma imagine showing a hypoechoic homogeneous mass originated from the 4^th layer; D: Rectal carcinoid imagine showing a submucosal hypoechoic mass with a homogenous echo. Courtesy by PH Zhou (Zhou, 2004 128 /id).