Clin Endosc.  2016 Sep;49(5):425-433. 10.5946/ce.2016.065.

Endoscopic Ultrasonography in the Diagnosis of Gastric Subepithelial Lesions

• Gong EJ
• Kim DH

• KMID: 2356047
• DOI: http://doi.org/10.5946/ce.2016.065

Abstract

Subepithelial lesions occasionally found in the stomach of patients undergoing endoscopy may be either benign lesions or tumors with malignant potential. They may also appear due to extrinsic compression. Discrimination of gastric subepithelial lesions begins with meticulous endoscopic examination for size, shape, color, mobility, consistency, and appearance of the overlying mucosa. Accurate diagnosis can be achieved with endoscopic ultrasonography, which provides useful information on the exact size, layer-of-origin, and characteristic morphologic features to support a definitive diagnosis. Endoscopic ultrasonography also aids in the prediction of malignant potential, especially in gastrointestinal stromal tumors. Features of subepithelial lesions identified on endoscopic ultrasonography can be used to determine whether further diagnostic procedures such as endoscopic resection, fine needle aspiration, or core biopsy are required. Endoscopic ultrasonography is a valuable tool for diagnosis and clinical decision making during follow-up of gastric subepithelial lesions.

Keyword

Endosonography; Stomach neoplasms; Diagnosis

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Clinical Decision-Making
Diagnosis*
Discrimination (Psychology)
Endoscopy
Endosonography*
Follow-Up Studies
Gastrointestinal Stromal Tumors
Humans
Mucous Membrane
Stomach
Stomach Neoplasms

Figure

• 

  Fig. 1. Extramural lesion. (A) Bulge of the gastric body mimicking a subepithelial lesion. (B) Endoscopic ultrasonography showing intact gastric wall layers and compression by the gallbladder. (C) Subepithelial lesion in the gastric body. (D) Corresponding endoscopic ultrasonography image showing an anechoic cystic lesion of the liver.

• 

  Fig. 2. Representative subepithelial lesions with typical features. (A, B) Gastric lipoma. (A) Endoscopic appearance of the lipoma located in the gastric antrum. (B) Endoscopic ultrasonography showing a hyperechoic, homogeneous mass arising from the third sonographic layer of the gastric wall. (C, D) Gastric varix. (C) Bulging, mass-like lesion in the gastric fundus and cardia. (D) Endoscopic ultrasonography showing anechoic, tubular, submucosal vascular structures. (E, F) Granular cell tumor. (E) Molar tooth-like, polypoid lesion in the gastric body. (F) Endosonographic image showing hypoechoic, homogeneous lesion with a smooth margin located in the second and third layers of the gastric wall.

• 

  Fig. 3. Heterotopic pancreas. (A-C) Endoscopic findings of heterotopic pancreas located in the gastric antrum. (D-F) Corresponding endoscopic ultrasonography images showing hypoechoic lesions with internal anechoic ductal structures involving the third and fourth layers of the gastric wall.

• 

  Fig. 4. Gastric inflammatory fibroid polyp. (A-C) Endoscopic images showing a small, polypoid lesion in the gastric antrum. (D-F) Endoscopic ultrasonography showing a hypoechoic lesion with indistinct margins located in the second layer of the gastric wall.

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  Fig. 5. Gastric carcinoid tumor. (A-C) Endoscopic images of a small, round, polypoid lesion with central umbilication in the gastric body. (D-F) Endoscopic ultrasonography showing a hypoechoic lesion with indistinct margins located in the second and third layers of the gastric wall.

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  Fig. 6. Hypoechoic lesions arising from the muscularis propria. Endoscopic and corresponding endosonographic images of a (A, B) leiomyoma, (C, D) gastrointestinal stromal tumor and (E, F) schwannoma.

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