Gastroenterology

Gastroenterology

Volume 130, Issue 7, June 2006, Pages 2217-2228
Gastroenterology

American Gastroenterological Association Institute
American Gastroenterological Association Institute Technical Review on the Management of Gastric Subepithelial Masses

https://doi.org/10.1053/j.gastro.2006.04.033Get rights and content

This literature review and the recommendations therein were prepared for the American Gastroenterological Association Institute Clinical Practice and Economics Committee. The paper was approved by the Committee on January 19, 2006, and by the AGA Institute Governing Board on April 20, 2006.

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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