American Gastroenterological Association InstituteAmerican Gastroenterological Association Institute Technical Review on the Management of Gastric Subepithelial Masses
Section snippets
Epidemiology
The endoscopic appearance of a subepithelial lesion in the stomach is that of a mass, bulge, or impression visible within the gastric lumen that is covered by normal-appearing epithelium. While every endoscopist has encountered subepithelial lesions during endoscopy, the frequency of finding such lesions is likely to vary according to the size and location of the mass as well as the care taken during the endoscopic examination. The prevalence of subepithelial gastric masses on routine
Endoscopy
The evaluation of subepithelial masses begins with the initial endoscopy. Features of subepithelial masses that can be assessed during endoscopy include an estimate of the size, shape, mobility, consistency (pillow sign, firm, cystic), pulsation, color, and mucosal appearance. In general, subepithelial masses have normal-appearing mucosa overlying the lesion, although erythema or inflammation on histologic examination of mucosal biopsy specimens unrelated to the underlying mass can be present.
Differential Diagnosis
The differential diagnosis of a gastric subepithelial mass depends on whether the lesion represents compression from a normal or abnormal structure adjacent to the gastric wall or if it originates from the wall itself. A brief description of lesions in the differential diagnosis of subepithelial lesions is presented with a description of the corresponding findings on EUS examination and additional methods that can be used to obtain tissue to establish the diagnosis. The differential diagnoses
Management
The management of gastric subepithelial lesions depends on the diagnosis determined using the findings at endoscopy, EUS, and biopsy. Many benign gastric subepithelial masses, including lipomas, varices, pancreatic rests, duplication cysts, and extramural compression from normal structures, require no further evaluation or follow-up. The management of frankly malignant lesions is also straightforward in that all such lesions require complete removal by either surgical or endoscopic resection.
Conclusions
Identifying a subepithelial mass during endoscopy is common. Further evaluation with EUS allows for improved characterization of subepithelial lesions, aiding the clinician in narrowing the differential diagnosis; however, the specificity of EUS imaging findings alone has been disappointing. It must be emphasized that despite the lack of specificity of EUS in diagnosing the etiology of subepithelial lesions, it remains the best test for determining the need for further evaluation, endoscopic
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