Clinical course of subepithelial lesions detected on upper gastrointestinal endoscopy

Abstract

Aim: To evaluate the natural history of subepithelial lesions.

Methods: We reviewed the medical records of 104159 patients who underwent upper gastrointestinal endoscopy at the Center for Health Promotion of Samsung Medical Center between 1996 and 2003. Subepithelial lesions were detected in 795 patients (0.76%); 252 patients were followed using upper gastrointestinal endoscopy for 82.5 +/- 29.2 mo (range, 12-160 mo; median, 84 mo; 1st quartile, 60 mo; 3rd quartile, 105 mo). The median interval of follow-up endoscopy was 12 mo (range, 6-105 mo; 1st quartile, 12 mo; 3rd quartile, 24 mo).

Results: The mean patient age was 53 years (range, 22-80 years), and the male-to-female ratio was 2.36:1 (177/75). The lesion size at initial measurement averaged 8.9 mm (range, 2-25 mm; median, 8 mm; 1st quartile, 5 mm; 3rd quartile, 10 mm). Of the 252 lesions, 244 (96.8%) were unchanged and 8 (3.2%) were significantly increased in size (from 12.9 +/- 6.0 to 21.2 +/- 12.2 mm) after a mean interval of 59.1 +/- 27.5 mo (range, 12-86 mo). Surgical resection of lesions was performed when the lesions were > or = 3 cm in diameter. Two lesions were diagnosed as gastrointestinal stromal tumors with an intermediate or high risk of malignancy and one lesion was classified as a schwannoma.

Conclusion: Most small subepithelial lesions do not change as shown by endoscopic examination, and regular follow-up with endoscopy may be considered in small, subepithelial lesions, especially lesions < 1 cm in size.

Figure 1

Clinical course of subepithelial masses.

Figure 2

Endoscopic, endoscopic ultrasonography (EUS), and gross findings of gastrointestinal stromal tumors (GISTs). A: Endoscopic view of a round subepithelial mass with a significant interval change; B: EUS shows an ovoid, homogeneous, hypoechoic mass in the fourth gastric wall layer; C: Gross findings of wedge resection reveal a soft, well-defined mass measuring 4.3 cm × 2.7 cm; D: Malignant potential.

Figure 3

Endoscopic, EUS, and gross findings of GISTs. A: Endoscopic view of a round subepithelial mass with a significant interval change; B: EUS shows an ovoid, homogeneous, hypoechoic mass in the fourth gastric wall layer; C: Gross findings of wedge resection reveal a soft, well-defined mass measuring 3.0 cm × 2.5 cm; D: Malignant potential.

Figure 4

Endoscopic, EUS, abdominal computed tomography (CT), and gross findings of a schwannoma. A: Endoscopic view of an ovoid subepithelial mass with a significant interval change; B: EUS shows a round, homogeneous, hypoechoic mass in the third gastric wall layer; C: CT scan shows a 2.8 cm × 2.2 cm homogeneous, well-defined, soft tissue mass on the upper body of the stomach; D: Gross findings of wedge resection reveal a 3 cm × 2.5 cm well-demarcated, round, firm, yellow mass.