EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New?

Abstract

Gastric subepithelial lesions (SELs) are intramural lesions that arise underneath the gastric mucosa. SELs can be benign, but can also be malignant or have malignant potential. Therefore, correct diagnosis is crucial. Endosonography has been established as the diagnostic gold standard. Although the identification of some of these lesions can be carried out immediately, solely based on their echo characteristics, for certain lesions histological examination is necessary. Sometimes histology can be inconclusive, especially for smaller lesions. Therefore, new methods have been developed in recent years to assist decision making, such as contrast enhanced endosonography, EUS elastography, and artificial intelligence systems. In this narrative review we provide a complete overview of the gastric SELs and summarize the new data of the last ten years concerning the diagnostic advances of endosonography on this topic.

Keywords: EUS elastography; EUS-AI; contrast-enhanced EUS; endoscopic ultrasound; gastric subepithelial lesions; keyword.

Figure 1

Subepithelial lesion at the gastric body. (A) Endoscopic image, note the small erosion on the tip of the lesion. (B) Radial EUS of the lesion; size approximately 15 × 15 mm, note that the lesion arises from the muscularis propria, is hypoechoic, and slightly heterogenous with sharp border. DD GIST, less likely schwannoma or leiomyoma. (C) EUS-FNB of the lesion with radial EUS. Note the needle (arrow) inside the lesion. (D) Specimen obtained; histological assessment verified the suspected diagnosis of a gastric GIST.