Clin Endosc.  2023 Nov;56(6):744-753. 10.5946/ce.2023.005.

Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study

• Choe Y
• Cho YK
• Kim GH
• Choi JH
• Kim ES
• Kim JH
• Choi EK
• Kim TH
• Kim SH
• Kim DH
• The Research Group for Endoscopic Ultrasound in Korean Society of Gastrointestinal Endoscopy

• KMID: 2547896
• DOI: http://doi.org/10.5946/ce.2023.005

Abstract

Background/Aims
This study aimed to evaluate the prevalence and natural progression of subepithelial lesions (SELs) in the upper gastrointestinal (UGI) tract.
Methods
The medical records of patients with UGI SELs who underwent endoscopic screening at eight university hospitals between January and December 2010 were retrospectively investigated. The follow-up evaluations were performed until December 2016.
Results
UGI SELs were found in 1,044 of the 65,233 participants screened (endoscopic prevalence, 1.60%; the total number of lesions, 1,062; mean age, 55.1±11.2 years; men, 53.6%). The median follow-up period was 48 (range, 8–74) months. SELs were most frequently found in the stomach (63.8%) and had a mean size of 9.9±6.1 mm. Endoscopic ultrasonography (EUS) was performed in 293 patients (28.1%). The most common lesions were leiomyomas, followed by gastrointestinal stromal tumors (GISTs), and ectopic pancreas. The proportions of SELs with malignant potential according to size were 3% (<1 cm), 22% (1–2 cm), 27% (2–3 cm), and 38% (≥3 cm). In gastric SELs larger than 1 cm, resections were performed in 20 patients because of an increase in size, of which 12 were found to be GISTs.
Conclusions
The prevalence of UGI SELs was 1.60%. Further, 23% of gastric SELs ≥1 cm were precancerous lesions, most followed by EUS and clinical decisions without initial pathological confirmation.

Keyword

Endoscopic ultrasonography; Natural history; Prevalence; Subepithelial lesions

Figure

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  Fig. 1. Study population. There were 29 cases of subepithelial lesions resected immediately after diagnosis, and 25 cases resected after follow-up gastroscopy.

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  Fig. 2. Distribution of upper gastrointestinal subepithelial lesions (SELs) according to size. (A) Types of SELs of 2 cm or more. (B, C) Comparison of the proportion of malignancy or premalignant gastric SELs by size. Malignancy or premalignant lesions included gastrointestinal stromal tumors, neuroendocrine tumors, and gastric cancer. BGH, Brunner’s gland hyperplasia; Ext., external; GIST, gastrointestinal stromal tumor.

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  Fig. 3. Natural course of gastric subepithelial lesions (SELs) according to size. (A) Gastric SELs measuring 1 to 2 cm in size. (B) Gastric SELs larger than >2 cm. Bx., biopsy; GCP, gastritis cystica profunda; IFP, inflammatory fibroid polyp; FNA/B, fine needle aspira­tion/biopsy; ER, endoscopic resection; Eo., eosinophilic; GIST, gastrointestinal stromal tumor; AGC, advanced gastric cancer.

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  Fig. 4. Clinical practice and natural course of (A) esophageal and (B) duodenal subepithelial lesions. Bx., biopsy; ER, endoscopic resection; GCT, granular cell tumor; GIST, gastrointestinal stromal tumor; F/U, follow-up; BGA, Brunner’s gland adenoma; BGH, Brunner’s gland hyperplasia; NET, neuroendocrine tumor; FNA, fine needle aspiration.

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