BACKGROUND Digestive tract subepithelial lesions(SELs)are relatively common,and early diagnosis and treatment are critical for improving patient quality of life and prognosis.However,diagnostic uncertainty often leads...BACKGROUND Digestive tract subepithelial lesions(SELs)are relatively common,and early diagnosis and treatment are critical for improving patient quality of life and prognosis.However,diagnostic uncertainty often leads to negative psychological effects,including anxiety and depression.AIM To investigate the prevalence of anxiety and depressive symptoms and identify associated factors among patients with digestive tract SELs.METHODS This retrospective study included 296 consecutive patients diagnosed with digestive tract SELs at the Affiliated Hospital of North Sichuan Medical College Endoscopy Center between October 2024 and April 2025.Demographic and clinical data were collected through standardized questionnaires.Anxiety and depression were assessed using the Self-Rating Anxiety Scale and the Self-Rating Depression Scale,respectively,while sleep quality was evaluated using the Pittsburgh Sleep Quality Index.Participants were classified into anxiety vs nonanxiety and depression vs non-depression groups based on established cutoff scores,and potential determinants were examined.RESULTS Anxiety symptoms were observed in 35.8%of cases(mean Self-Rating Anxiety Scale score:46.56±9.13)and depressive symptoms in 33.1%(mean Self-Rating Depression scale score:48.64±8.30).Pittsburgh Sleep Quality Index scores were positively correlated with both anxiety and depression(P<0.05).Univariate analysis identified age,annual income,sleep disorders,and endoscopic ultrasonography(EUS)evaluation status as significant factors(P<0.05).Multivariable analysis revealed that low annual income(<10000 Chinese yuan)and sleep disorders were independent risk factors,whereas undergoing EUS examination and having disease awareness were protective factors against anxiety and depression(P<0.05).CONCLUSION Patients with digestive tract SELs are at increased risk for anxiety and depression,with poor sleep strongly linked to worsening psychological symptoms.Early diagnostic assessment with EUS appears to serve a protective role against the onset of these psychological disorders.展开更多
In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumo...In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumor.GISTs originate from the interstitial cells of Cajal,which are pacemaker cells involved in gut motility.GISTs are most commonly found in the stomach and small intestine,but esophageal involvement is rare.Esophageal GISTs account for<1%of all GISTs.Endoscopic resection remains the mainstay for small,localized tumors with excellent outcomes.However,larger tumors may require multidisciplinary strategies to provide the best oncological outcomes.Here,we discuss the usefulness of endoscopic ultrasound(EUS)of subepithelial tumors of the upper gastrointestinal tract.EUS is a crucial tool in the diagnosis,staging,and management of subepithelial masses.Given the subepithelial nature of these tumors,standard endoscopy is not adequate,making EUS essential for a comprehensive assessment.EUS provides accurate tumor size assessment and enables fine needle aspirations guided biopsy,for treatment planning.展开更多
BACKGROUND Submucosal tumors arise from the subepithelial layer anywhere along the gastr-ointestinal tract,most commonly in the stomach.A wide range of lesions,from benign to malignant,may present as gastric submucosa...BACKGROUND Submucosal tumors arise from the subepithelial layer anywhere along the gastr-ointestinal tract,most commonly in the stomach.A wide range of lesions,from benign to malignant,may present as gastric submucosal tumors.However,the gastric involvement of Crohn’s disease(CD)is generally not considered in the differential diagnosis of such lesions.CASE SUMMARY A 23-year-old male patient presented with a gastric subepithelial tumor.The medical history included CD.Diagnostic workup revealed a 3-cm mucosal lesion with a central ulceration on the posterior wall of the distal antrum.The patient underwent laparoscopic wedge resection of stomach,and the postoperative course was uneventful.Histopathological analysis confirmed a diagnosis of gastric CD presenting as a subepithelial tumor.CONCLUSION Despite its rarity,upper gastrointestinal CD can present as a gastric subepithelial tumor,warranting consideration in young patients with CD.展开更多
BACKGROUND Gastric subepithelial lesions(SELs)are elevated lesions originating from the muscularis mucosa,submucosa,or muscularis propria,and may also include extraluminal lesions.For small SELs(less than 5 cm),comple...BACKGROUND Gastric subepithelial lesions(SELs)are elevated lesions originating from the muscularis mucosa,submucosa,or muscularis propria,and may also include extraluminal lesions.For small SELs(less than 5 cm),complete endoscopic excision is the preferred treatment.Endoscopic full-thickness resection(EFTR)has proven to be an effective approach.AIM To evaluate the efficacy of the interrupted closure technique compared to the traditional closure technique in EFTR for gastric SELs.METHODS This single-center,prospective,randomized controlled trial was conducted at a tertiary hospital from September 2023 to September 2024.A total of 90 patients who underwent EFTR for gastric SELs were randomly allocated to either the interrupted closure group(n=44)or the traditional closure group(n=46).RESULTS All patients had complete resection and wound closure without any severe postoperative complications.The incidence of intraoperative gas-related complications was significantly lower in the interrupted closure group than in the traditional closure group(2.27%vs 26.09%,P=0.001),demonstrating interrupted closure technique can reduce the incidence of gas-related issues.Statistical analysis revealed that the incidence of postoperative infection was significantly lower in the experimental group than in the control group(15.91%vs 41.30%,P=0.008).Additionally,the median duration of antibiotic use was lower in the experimental group(3.5 days vs 5 days,P=0.013).Abdominal pain levels on postoperative days 1 and 4 were also lower in the experimental group compared to the control group(P<0.001).CONCLUSION The interrupted closure technique in EFTR for treating gastric SELs is safe and effective,reducing the incidence of intraoperative gas complications and postoperative infections.展开更多
Endoscopic ultrasonography(EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors,due to its higher sensitivity and specificity than other imaging modalities.EUS can characterize lesions...Endoscopic ultrasonography(EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors,due to its higher sensitivity and specificity than other imaging modalities.EUS can characterize lesions by providing information on echogenic origin,size,borders,homogeneity,and the presence of echogenic or anechoic foci.Linear echoendoscopes,and recently also electronic radial echoendoscopes,can be used with color Doppler or power Doppler to assess the vascular signals from subepithelial masses,and thus permit the differentiation of vascular structures from cysts,as well as the assessment of the tumor blood supply.However,the diagnostic accuracy of EUS imaging alone has been shown to be low in subepithelial lesions with 3rd and 4th layers.It is also difficult to differentiate exactly between benign and malignant tumors and to gain an accurate picture of histology using EUS.On the other hands,EUS guided fine needle aspiration(EUS-FNA) can provide samples for cytologic or histologic analysis.Hypoechoic lesions of the 3rd and the 4th EUS layers,more than in 1 cm diameter are recommended,and histologic confirmation using endoscopic submucosal resection or EUSFNA should be obtained when possible.Therefore,EUSFNA plays an important role in the clinical management of subepithelial tumors.Furthermore improvements in endoscopic technology are expected to be more useful modalities in differential diagnosis and discrimination between benign and malignant subepithelial展开更多
Minimally invasive endoscopic resection has become an increasingly popular method for patients with small(less than 3.5 cm in diameter) gastric subepithelial tumors(SETs) originating from the muscularis propria(MP) la...Minimally invasive endoscopic resection has become an increasingly popular method for patients with small(less than 3.5 cm in diameter) gastric subepithelial tumors(SETs) originating from the muscularis propria(MP) layer. Currently, the main endoscopic therapies for patients with such tumors are endoscopic muscularis excavation, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection. Although these endoscopic techniques can be used for complete resection of the tumor and provide an accurate pathological diagnosis, these techniques have been associated with several negative events, such as incomplete resection, perforation, and bleeding. This review provides detailed information on the technical details, likely treatment outcomes, and complications associated with each endoscopic method for treating/removing small gastric SETs that originate from the MP layer.展开更多
Gastric abscess is a localized pyogenic inflammation of the gastric wall, which is a rare form of suppurative gastritis. The rarity of gastric abscess may be associated with the difficulty of early diagnosis and high ...Gastric abscess is a localized pyogenic inflammation of the gastric wall, which is a rare form of suppurative gastritis. The rarity of gastric abscess may be associated with the difficulty of early diagnosis and high mortality as a result. In general, subepithelial lesions (SELs) of the stomach are incidentally detected during the course of upper endoscopy without specific clinical symptoms and signs. However, some gastric SELs present rarely as a form of hemorrhage, obstruction, perforation, and abscess. Here we report a 45-year-old man with gastric SEL presenting as a gastric abscess, which was diagnosed as an ectopic pancreas of the stomach, along with a review of the literature. Although gastric SEL presenting as an abscess is known as a serious and life-threatening lesion, the patient made a complete recovery through surgical resection as well as medical treatment.展开更多
A 21-year-old male visited our hospital with a complaint of aggravating dysphagia and odynophagia for a few days.Esophagogastroduodenoscopy showed huge bulging mucosa with an intact surface causing luminal narrowing a...A 21-year-old male visited our hospital with a complaint of aggravating dysphagia and odynophagia for a few days.Esophagogastroduodenoscopy showed huge bulging mucosa with an intact surface causing luminal narrowing at 35 cm from the incisor teeth.Endoscopic ultrasonography showed an about 35 mm sized irregular margined in-homogenous hypoechoic lesion with an obscure layer of origin.Endoscopic ultrasonography fine needle aspiration revealed spindle cell proliferation without immunoreactivity for CD117,SMA,and cytokeratin.The patient underwent excision of the subepithelial lesion at the distal esophagus.On pathologic examination of the specimen,the tumor was composed of short fascicles of oval to spindle cells with eosinophilic and clear cytoplasm and vesicular nuclei.The tumor cells were positive for S-100 and SOX10and negative for CD117,SMA,HMB-45,melan-A,cytokeratin,and CD99.The split-apart signal was detected in EWSR1 on FISH,suggesting a malignant gastrointestinal neuroectodermal tumor.At the time of writing,the patient is on radiation therapy at the operated site of esophagus and doing well,with no recurrence for three months.Malignant gastrointestinal neuroectodermal tumor is a rare gastrointestinal tumor with features of clear cell sarcoma,without melanocytic differentiation,and shows a poor prognosis.This is the first reported case of malignant gastrointestinal neuroectodermal tumor arising as subepithelial lesion in the esophagus.展开更多
With the wide use of esophagogastroduodenoscopy,the incidence of gastric subepithelial tumor(SET)diagnosis has increased.While the management of large orsymptomatic gastric SETs is obvious,treatment of small(≤3 cm)as...With the wide use of esophagogastroduodenoscopy,the incidence of gastric subepithelial tumor(SET)diagnosis has increased.While the management of large orsymptomatic gastric SETs is obvious,treatment of small(≤3 cm)asymptomatic gastric SETs remains inconclusive.Moreover,the presence of gastrointestinal stromal tumors with malignant potential is of concern,and endoscopic treatment of gastric SETs remains a subject of debate.Recently,numerous studies have demonstrated the feasibility of endoscopic treatment of gastric SETs,and have proposed various endoscopic procedures including endoscopic submucosal dissection,endoscopic muscularis dissection,endoscopic enucleation,endoscopic submucosal tunnel dissection,endoscopic full-thickness resection,and a hybrid approach(the combination of endoscopy and laparoscopy).In this review article,we discuss current endoscopic treatments for gastric SETs as well as the advantages and limitations of this type of therapy.Finally,we predict the availability of newly developed endoscopic treatments for gastric SETs.展开更多
AIM:To evaluate the natural history of subepithelial lesions.METHODS:We reviewed the medical records of 104 159 patients who underwent upper gastrointestinal endoscopy at the Center for Health Promotion of Samsung Med...AIM:To evaluate the natural history of subepithelial lesions.METHODS:We reviewed the medical records of 104 159 patients who underwent upper gastrointestinal endoscopy at the Center for Health Promotion of Samsung Medical Center between 1996 and 2003.Subepithelial lesions were detected in 795 patients(0.76%);252 patients were followed using upper gastrointestinal endoscopy for 82.5 ± 29.2 mo(range,12-160 mo;median,84 mo;1st quartile,60 mo;3rd quartile,105 mo).The median interval of follow-up endoscopy was 12 mo(range,6-105 mo;1st quartile,12 mo;3rd quartile,24 mo).RESULTS:The mean patient age was 53 years(range,22-80 years),and the male-to-female ratio was 2.36:1(177/75).The lesion size at initial measurement averaged 8.9 mm(range,2-25 mm;median,8 mm;1st quartile,5 mm;3rd quartile,10 mm).Of the 252 lesions,244(96.8%) were unchanged and 8(3.2%) were significantly increased in size(from 12.9 ± 6.0 to 21.2 ± 12.2 mm) after a mean interval of 59.1 ± 27.5 mo(range,12-86 mo).Surgical resection of lesions was performed when the lesions were ≥ 3 cm in diameter.Two lesions were diagnosed as gastrointestinal stromal tumors with an intermediate or high risk of malignancy and one lesion was classified as a schwannoma.CONCLUSION:Most small subepithelial lesions do not change as shown by endoscopic examination,and regular follow-up with endoscopy may be considered in small,subepithelial lesions,especially lesions < 1 cm in size.展开更多
We describe an uncommon case of a patient with a metastatic adenocarcinoma of ovarian origin presented as a gastric subepithelial tumor(SET)and that was diagnosed by endoscopic ultrasound fine-needle biopsy(EUS-FNB).M...We describe an uncommon case of a patient with a metastatic adenocarcinoma of ovarian origin presented as a gastric subepithelial tumor(SET)and that was diagnosed by endoscopic ultrasound fine-needle biopsy(EUS-FNB).Malignant gastric lesions are rarely metastatic and the primary tumor is mainly breast,lung,esophageal cancer or cutaneous melanoma.Gastric metastasis from ovarian cancer is unusual,presenting synchronously with the primary tumor but also several years later than the initial diagnosis.From an endoscopic point of view,gastric metastasis does not present specific features.They may mimic both a primary gastric tumor or,less frequently,an SET.This case demonstrates the importance of EUS-FNB in distinguishing SETs and how this may alter treatment and prognosis.展开更多
Diagnosis of gastric subepithelial tumor(SET) has shown a rapid increase worldwide.Although,until now,endoscopic ultrasound guided procedures such as fine needle aspiration have shown relatively high accuracy in diagn...Diagnosis of gastric subepithelial tumor(SET) has shown a rapid increase worldwide.Although,until now,endoscopic ultrasound guided procedures such as fine needle aspiration have shown relatively high accuracy in diagnosis of SET,the most important modality for diagnosis and treatment of SETs is complete resection such as endoscopic or surgical resection.However,endoscopic resection or laparoscopic wedge resection alone also has some limitations.Endoscopic resection is difficult to perform in cases of gastric SET located within deep portion of the gastric layer or a relatively large(larger than 25 mm diameter).On the other hand,gastric SET in a difficult location,such as the gastroesophageal junction or pyloric ring is challenging for laparoscopic surgical resection.The hybrid natural orifice transluminal endoscopic surgery(NOTES) technique is a combined method,including the advantages of both laparoscopic resection and endoscopic resection for gastric SETs.This method may be performed safely with reasonable operation times,less bleeding,and adequate resection margin and regardless of tumor size.In particular,in the case of a difficult location for resection,such as the esophagogastric junction or pyloric ring,hybrid NOTES is currently believed to be an ideal treatment method.展开更多
BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resectio...BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resection techniques are time-consuming and lack efficacy for small SEL-MPs.AIM To evaluate the efficacy and safety of ligation-assisted endoscopic submucosal resection(ESMR-L)following unroofing technique for small esophageal SEL-MPs.METHODS From January 2021 to September 2023,17 patients diagnosed with esophageal SEL-MPs underwent ESMR-L following unroofing technique at the endoscopy center of Shenzhen People’s Hospital.Details of clinicopathological characteristics and clinical outcomes were collected and analyzed.RESULTS The mean age of the patients was 50.12±12.65 years.The mean size of the tumors was 7.47±2.83 mm and all cases achieved en bloc resection successfully.The average operation time was 12.2 minutes without any complications.Histopathology identified 2 Lesions(11.8%)as gastrointestinal stromal tumors at very low risk,12 Lesions(70.6%)as leiomyoma and 3 Lesions(17.6%)as smooth muscle proliferation.No recurrence was found during the mean follow-up duration of 14.18±9.62 months.CONCLUSION ESMR-L following roofing technique is an effective and safe technique for management of esophageal SEL-MPs smaller than 20 mm,but it cannot ensure en bloc resection and may require further treatment.展开更多
Endoscopic ultrasound tissue acquisition,in the form of both fine needle aspiration(EUS-FNA)and fine needle biopsy(EUS-FNB),is utilized for pancreatic mass lesions,subepithelial lesions,and lymph node biopsy.Both proc...Endoscopic ultrasound tissue acquisition,in the form of both fine needle aspiration(EUS-FNA)and fine needle biopsy(EUS-FNB),is utilized for pancreatic mass lesions,subepithelial lesions,and lymph node biopsy.Both procedures are safe and yield high diagnostic value.Despite its high diagnostic yield,EUS-FNA has potential limitations associated with cytological aspirations,including inability to determine histologic architecture,and a small quantitative sample for further immunohistochemical staining.EUS-FNB,with its larger core biopsy needle,was designed to overcome these potential limitations.However,it remains unclear which technique should be used and for which lesions.Comparative trials are plagued by heterogeneity at every stage of comparison;including variable needles used,and different definitions of endpoints,which therefore limit generalizability.Thus,we present a review of prospective trials,systematic reviews,and meta-analyses on studies examining EUS-FNA vs EUSFNB.Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic mass lesions,and yield conflicting results in terms of demonstrating the superiority of one method.However,consistent among trials is the potential for diagnosis with fewer passes,and a larger quantity of sample achieved for next generation sequencing.With regard to subepithelial lesions and lymph node biopsy,fewer prospective trials exist,and larger prospective studies are necessary.Based on the available literature,we would recommend EUS-FNB for peri-hepatic lymph nodes.展开更多
AIM:To observe the changes in corneal subepithelial nerve fibers(CNFs)and Langerhans cells(LCs)in patients with type 2 diabetes using corneal laser confocal microscopy(CLCM).METHODS:A total of 60 patients(64 eyes),inc...AIM:To observe the changes in corneal subepithelial nerve fibers(CNFs)and Langerhans cells(LCs)in patients with type 2 diabetes using corneal laser confocal microscopy(CLCM).METHODS:A total of 60 patients(64 eyes),including 40 patients with type 2 diabetes(DM group)and 20 subjects without diabetes(control group)were included with CLCM.Neuron J plugin of Image J software were used for quantitative analysis of CNF length(CNFL),CNF density(CNFD),corneal nerve branch fiber density(CNBD),main branch length density,branch length density,corneal nerve fiber tortuosity(NT)score,and LCs density.An independent samples t-test to analyze the variability between the two groups was performed,and Pearson correlation analysis was used to analyze the relationships between CNF and multiple biochemical indicators in the DM group.The predictive power of CNF for type 2 diabetes was assessed using the receiver operating characteristic(ROC)curve.RESULTS:There were significant differences in the CNFL,CNFD,and main branch length density between two groups.The results of Pearson correlation analysis showed a significant negative correlation between CNFD and the duration of diabetes as well as triglyceride levels and total cholesterol,and a significant positive correlation between CNFD and serum albumin.In addition,the NT score showed a positive correlation and urea nitrogen,similar to the positive correlation observed between LC density and glycosylated hemoglobin(HbA1c)levels.CNFD showed the highest area under the curve(AUC of ROC)value,followed by main branch length density and CNFL.The AUC of the ROC curve under the logistic regression model also demonstrated good predictive values.The cut-off values of CNFD,CNFL,and main branch length density for diabetes showed 31.25,18.85,and 12.56,respectively.CONCLUSION:In patients with type 2 diabetes,there is a notable reduction in both CNFL and CNFD.These measurements can be influenced by various blood biochemical factors.However,the compromised nerve fibers can serve as valuable indicators for predicting the onset of type 2 diabetes and also as biomarkers for detecting diabetic neuropathy and its related complications.展开更多
Dear Sir,Iam Yonca A.Akova,MD-from the Department of Ophthalmology,Bayindir Kavaklidere Hospital,Turkey.I wrote this letter to evaluate the efficacy of 0.05%topical cyclosporine A（CsA）eye drops（Restasis Allergan,Ir...Dear Sir,Iam Yonca A.Akova,MD-from the Department of Ophthalmology,Bayindir Kavaklidere Hospital,Turkey.I wrote this letter to evaluate the efficacy of 0.05%topical cyclosporine A（CsA）eye drops（Restasis Allergan,Irvine,USA）in symptomatic patients with recurrent subepithelial infiltrates（SEIs）due to adenoviral keratoconjunctivitis following steroid eye drops tapering or discontinuation.展开更多
AIM: To evaluate the diagnostic yield and safety of a modified technique for the histological diagnosis of subepithelial tumors (SETs). METHODS: A retrospective review of patients who underwent a modified technique fo...AIM: To evaluate the diagnostic yield and safety of a modified technique for the histological diagnosis of subepithelial tumors (SETs). METHODS: A retrospective review of patients who underwent a modified technique for the histological diagnosis of gastric SETs, consisting of a mucosal incision with a fixed flexible snare (MIF) and deep-tissue biopsy under conventional endoscopic view, from January 2012 to January 2013 was performed. Eleven patients with gastric SETs 10-30 mm in diameter and originating from the third or fourth layer on endoscopic ultrasonography were included. RESULTS: The mean age was 59.8 (range, 45-76) years, and 5 patients were male. The mean size of the SETs was 21.8 (range, 11-30) mm. The number of biopsy specimens was 6.3 (range 5-8). The mean procedure time was 9.0 min (range, 4-17 min). The diagnostic yield of MIF biopsies was 90.9% (10/11). The histological diagnoses were leiomyoma (4/11, 36.4%), aberrant pancreas (3/11, 27.3%), gastrointestinal stromal tumors (2/11, 18.2%), an inflammatory fibrinoid tumor (1/11, 9.1%); one result was non-diagnostic (1/11, 9.1%). There were six mesenchymal tumors; the specimens obtained in each case were sufficient for an immunohistochemical diagnosis. There was no major bleeding, but one perforation occurred that was successfully controlled by endoscopic clipping. CONCLUSION: The MIF biopsy was simple to perform, safe, and required a shorter procedure time, with a high diagnostic yield for small SETs.展开更多
Endoscopic ultrasonography is the most accurate procedure for the evaluation of subepithelial lesions. The finding of a homogeneous, hyperechoic, well-delimited lesion, originating from the third layer of the gastroin...Endoscopic ultrasonography is the most accurate procedure for the evaluation of subepithelial lesions. The finding of a homogeneous, hyperechoic, well-delimited lesion, originating from the third layer of the gastrointestinal tract(submucosa) suggests a benign tumor,generally lipoma. As other differential diagnoses have not been reported, echoendoscopists might not pursue a definitive pathological diagnosis or follow-up the patient. This case series aims to broaden the spectrum of differential diagnosis for duodenal hyperechoic third layer subepithelial lesions by providing four different and relevant pathologies with this echoendoscopic pattern.展开更多
BACKGROUND Rectal subepithelial lesions(SELs) are commonly seen in endoscopic examination, generally manifested as bumps with a smooth surface. Precise preoperative diagnoses for rectal SELs are difficult because abno...BACKGROUND Rectal subepithelial lesions(SELs) are commonly seen in endoscopic examination, generally manifested as bumps with a smooth surface. Precise preoperative diagnoses for rectal SELs are difficult because abnormal tissues are not easily to be obtained by regular endoscopic forceps biopsy. Traditional guidance modalities of preoperative biopsy, including endoscopic ultrasound, computed tomography, and transabdominal ultrasound, are often unsatisfactory. An updated, safe, and effective biopsy guidance method is required. We herein report a new biopsy guidance modality—endorectal ultrasound(ERUS) combined with contrastenhanced ultrasound(CEUS).CASE SUMMARY A 32-year-old woman complained of a mass inside the rectovaginal space for 9 years, which became enlarged within 1 year. A rectal SEL detected by endoscopy was suspected to be a gastrointestinal stromal tumor or exophytic uterine fibroid. Pathological diagnosis was difficult because of unsuccessful transabdominal core needle biopsy with insufficient tissues, as well as vaginal hemorrhage. A second biopsy was suggested after multiple disciplinary treatment discussion, which referred to a transperineal core needle biopsy(CNB) guided by ERUS combined with CEUS. Adequate samples were procured and rectal gastrointestinal stromal tumor was proved to be the pathological diagnosis. Imatinib was recommended for first-line therapy by multiple disciplinary treatment discussion. After the tumor shrunk, resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall. Adjuvant therapy was applied and no recurrence or metastasis has been found by the last follow-up on December 13, 2019.CONCLUSION Transperineal CNB guided by ERUS and CEUS is a safe and effective preoperative biopsy of rectal SELs yet with some limitations.展开更多
Management of subepithelial tumors(SETs) remains challenging. Endoscopic ultrasound(EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the mino...Management of subepithelial tumors(SETs) remains challenging. Endoscopic ultrasound(EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods.展开更多
基金Supported by Nanchong Social Science Research“14^(th) Five-Year Plan”2025 Annual Project,No.NC25B244.
文摘BACKGROUND Digestive tract subepithelial lesions(SELs)are relatively common,and early diagnosis and treatment are critical for improving patient quality of life and prognosis.However,diagnostic uncertainty often leads to negative psychological effects,including anxiety and depression.AIM To investigate the prevalence of anxiety and depressive symptoms and identify associated factors among patients with digestive tract SELs.METHODS This retrospective study included 296 consecutive patients diagnosed with digestive tract SELs at the Affiliated Hospital of North Sichuan Medical College Endoscopy Center between October 2024 and April 2025.Demographic and clinical data were collected through standardized questionnaires.Anxiety and depression were assessed using the Self-Rating Anxiety Scale and the Self-Rating Depression Scale,respectively,while sleep quality was evaluated using the Pittsburgh Sleep Quality Index.Participants were classified into anxiety vs nonanxiety and depression vs non-depression groups based on established cutoff scores,and potential determinants were examined.RESULTS Anxiety symptoms were observed in 35.8%of cases(mean Self-Rating Anxiety Scale score:46.56±9.13)and depressive symptoms in 33.1%(mean Self-Rating Depression scale score:48.64±8.30).Pittsburgh Sleep Quality Index scores were positively correlated with both anxiety and depression(P<0.05).Univariate analysis identified age,annual income,sleep disorders,and endoscopic ultrasonography(EUS)evaluation status as significant factors(P<0.05).Multivariable analysis revealed that low annual income(<10000 Chinese yuan)and sleep disorders were independent risk factors,whereas undergoing EUS examination and having disease awareness were protective factors against anxiety and depression(P<0.05).CONCLUSION Patients with digestive tract SELs are at increased risk for anxiety and depression,with poor sleep strongly linked to worsening psychological symptoms.Early diagnostic assessment with EUS appears to serve a protective role against the onset of these psychological disorders.
文摘In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumor.GISTs originate from the interstitial cells of Cajal,which are pacemaker cells involved in gut motility.GISTs are most commonly found in the stomach and small intestine,but esophageal involvement is rare.Esophageal GISTs account for<1%of all GISTs.Endoscopic resection remains the mainstay for small,localized tumors with excellent outcomes.However,larger tumors may require multidisciplinary strategies to provide the best oncological outcomes.Here,we discuss the usefulness of endoscopic ultrasound(EUS)of subepithelial tumors of the upper gastrointestinal tract.EUS is a crucial tool in the diagnosis,staging,and management of subepithelial masses.Given the subepithelial nature of these tumors,standard endoscopy is not adequate,making EUS essential for a comprehensive assessment.EUS provides accurate tumor size assessment and enables fine needle aspirations guided biopsy,for treatment planning.
文摘BACKGROUND Submucosal tumors arise from the subepithelial layer anywhere along the gastr-ointestinal tract,most commonly in the stomach.A wide range of lesions,from benign to malignant,may present as gastric submucosal tumors.However,the gastric involvement of Crohn’s disease(CD)is generally not considered in the differential diagnosis of such lesions.CASE SUMMARY A 23-year-old male patient presented with a gastric subepithelial tumor.The medical history included CD.Diagnostic workup revealed a 3-cm mucosal lesion with a central ulceration on the posterior wall of the distal antrum.The patient underwent laparoscopic wedge resection of stomach,and the postoperative course was uneventful.Histopathological analysis confirmed a diagnosis of gastric CD presenting as a subepithelial tumor.CONCLUSION Despite its rarity,upper gastrointestinal CD can present as a gastric subepithelial tumor,warranting consideration in young patients with CD.
基金Supported by the Shenyang Science and Technology,No.22-321-32-15Department of Science and Technology of Liaoning Province,No.2023JH2/101600015.
文摘BACKGROUND Gastric subepithelial lesions(SELs)are elevated lesions originating from the muscularis mucosa,submucosa,or muscularis propria,and may also include extraluminal lesions.For small SELs(less than 5 cm),complete endoscopic excision is the preferred treatment.Endoscopic full-thickness resection(EFTR)has proven to be an effective approach.AIM To evaluate the efficacy of the interrupted closure technique compared to the traditional closure technique in EFTR for gastric SELs.METHODS This single-center,prospective,randomized controlled trial was conducted at a tertiary hospital from September 2023 to September 2024.A total of 90 patients who underwent EFTR for gastric SELs were randomly allocated to either the interrupted closure group(n=44)or the traditional closure group(n=46).RESULTS All patients had complete resection and wound closure without any severe postoperative complications.The incidence of intraoperative gas-related complications was significantly lower in the interrupted closure group than in the traditional closure group(2.27%vs 26.09%,P=0.001),demonstrating interrupted closure technique can reduce the incidence of gas-related issues.Statistical analysis revealed that the incidence of postoperative infection was significantly lower in the experimental group than in the control group(15.91%vs 41.30%,P=0.008).Additionally,the median duration of antibiotic use was lower in the experimental group(3.5 days vs 5 days,P=0.013).Abdominal pain levels on postoperative days 1 and 4 were also lower in the experimental group compared to the control group(P<0.001).CONCLUSION The interrupted closure technique in EFTR for treating gastric SELs is safe and effective,reducing the incidence of intraoperative gas complications and postoperative infections.
基金Supported by The Japan Society for Promotion of Science,Research and Development Committee Program of The Japan Society of Ultrasonics in Medicine,Japan Research Foundation for Clinical Pharmacology,and Japanese Foundation for Research and Promotion of Endoscopy
文摘Endoscopic ultrasonography(EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors,due to its higher sensitivity and specificity than other imaging modalities.EUS can characterize lesions by providing information on echogenic origin,size,borders,homogeneity,and the presence of echogenic or anechoic foci.Linear echoendoscopes,and recently also electronic radial echoendoscopes,can be used with color Doppler or power Doppler to assess the vascular signals from subepithelial masses,and thus permit the differentiation of vascular structures from cysts,as well as the assessment of the tumor blood supply.However,the diagnostic accuracy of EUS imaging alone has been shown to be low in subepithelial lesions with 3rd and 4th layers.It is also difficult to differentiate exactly between benign and malignant tumors and to gain an accurate picture of histology using EUS.On the other hands,EUS guided fine needle aspiration(EUS-FNA) can provide samples for cytologic or histologic analysis.Hypoechoic lesions of the 3rd and the 4th EUS layers,more than in 1 cm diameter are recommended,and histologic confirmation using endoscopic submucosal resection or EUSFNA should be obtained when possible.Therefore,EUSFNA plays an important role in the clinical management of subepithelial tumors.Furthermore improvements in endoscopic technology are expected to be more useful modalities in differential diagnosis and discrimination between benign and malignant subepithelial
基金Supported by Project of the Zhejiang Province bureau of Health,No.2013KYA226 and No.2013KYA229Taizhou City science and Technology bureau(121ky08)
文摘Minimally invasive endoscopic resection has become an increasingly popular method for patients with small(less than 3.5 cm in diameter) gastric subepithelial tumors(SETs) originating from the muscularis propria(MP) layer. Currently, the main endoscopic therapies for patients with such tumors are endoscopic muscularis excavation, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection. Although these endoscopic techniques can be used for complete resection of the tumor and provide an accurate pathological diagnosis, these techniques have been associated with several negative events, such as incomplete resection, perforation, and bleeding. This review provides detailed information on the technical details, likely treatment outcomes, and complications associated with each endoscopic method for treating/removing small gastric SETs that originate from the MP layer.
文摘Gastric abscess is a localized pyogenic inflammation of the gastric wall, which is a rare form of suppurative gastritis. The rarity of gastric abscess may be associated with the difficulty of early diagnosis and high mortality as a result. In general, subepithelial lesions (SELs) of the stomach are incidentally detected during the course of upper endoscopy without specific clinical symptoms and signs. However, some gastric SELs present rarely as a form of hemorrhage, obstruction, perforation, and abscess. Here we report a 45-year-old man with gastric SEL presenting as a gastric abscess, which was diagnosed as an ectopic pancreas of the stomach, along with a review of the literature. Although gastric SEL presenting as an abscess is known as a serious and life-threatening lesion, the patient made a complete recovery through surgical resection as well as medical treatment.
文摘A 21-year-old male visited our hospital with a complaint of aggravating dysphagia and odynophagia for a few days.Esophagogastroduodenoscopy showed huge bulging mucosa with an intact surface causing luminal narrowing at 35 cm from the incisor teeth.Endoscopic ultrasonography showed an about 35 mm sized irregular margined in-homogenous hypoechoic lesion with an obscure layer of origin.Endoscopic ultrasonography fine needle aspiration revealed spindle cell proliferation without immunoreactivity for CD117,SMA,and cytokeratin.The patient underwent excision of the subepithelial lesion at the distal esophagus.On pathologic examination of the specimen,the tumor was composed of short fascicles of oval to spindle cells with eosinophilic and clear cytoplasm and vesicular nuclei.The tumor cells were positive for S-100 and SOX10and negative for CD117,SMA,HMB-45,melan-A,cytokeratin,and CD99.The split-apart signal was detected in EWSR1 on FISH,suggesting a malignant gastrointestinal neuroectodermal tumor.At the time of writing,the patient is on radiation therapy at the operated site of esophagus and doing well,with no recurrence for three months.Malignant gastrointestinal neuroectodermal tumor is a rare gastrointestinal tumor with features of clear cell sarcoma,without melanocytic differentiation,and shows a poor prognosis.This is the first reported case of malignant gastrointestinal neuroectodermal tumor arising as subepithelial lesion in the esophagus.
文摘With the wide use of esophagogastroduodenoscopy,the incidence of gastric subepithelial tumor(SET)diagnosis has increased.While the management of large orsymptomatic gastric SETs is obvious,treatment of small(≤3 cm)asymptomatic gastric SETs remains inconclusive.Moreover,the presence of gastrointestinal stromal tumors with malignant potential is of concern,and endoscopic treatment of gastric SETs remains a subject of debate.Recently,numerous studies have demonstrated the feasibility of endoscopic treatment of gastric SETs,and have proposed various endoscopic procedures including endoscopic submucosal dissection,endoscopic muscularis dissection,endoscopic enucleation,endoscopic submucosal tunnel dissection,endoscopic full-thickness resection,and a hybrid approach(the combination of endoscopy and laparoscopy).In this review article,we discuss current endoscopic treatments for gastric SETs as well as the advantages and limitations of this type of therapy.Finally,we predict the availability of newly developed endoscopic treatments for gastric SETs.
文摘AIM:To evaluate the natural history of subepithelial lesions.METHODS:We reviewed the medical records of 104 159 patients who underwent upper gastrointestinal endoscopy at the Center for Health Promotion of Samsung Medical Center between 1996 and 2003.Subepithelial lesions were detected in 795 patients(0.76%);252 patients were followed using upper gastrointestinal endoscopy for 82.5 ± 29.2 mo(range,12-160 mo;median,84 mo;1st quartile,60 mo;3rd quartile,105 mo).The median interval of follow-up endoscopy was 12 mo(range,6-105 mo;1st quartile,12 mo;3rd quartile,24 mo).RESULTS:The mean patient age was 53 years(range,22-80 years),and the male-to-female ratio was 2.36:1(177/75).The lesion size at initial measurement averaged 8.9 mm(range,2-25 mm;median,8 mm;1st quartile,5 mm;3rd quartile,10 mm).Of the 252 lesions,244(96.8%) were unchanged and 8(3.2%) were significantly increased in size(from 12.9 ± 6.0 to 21.2 ± 12.2 mm) after a mean interval of 59.1 ± 27.5 mo(range,12-86 mo).Surgical resection of lesions was performed when the lesions were ≥ 3 cm in diameter.Two lesions were diagnosed as gastrointestinal stromal tumors with an intermediate or high risk of malignancy and one lesion was classified as a schwannoma.CONCLUSION:Most small subepithelial lesions do not change as shown by endoscopic examination,and regular follow-up with endoscopy may be considered in small,subepithelial lesions,especially lesions < 1 cm in size.
文摘We describe an uncommon case of a patient with a metastatic adenocarcinoma of ovarian origin presented as a gastric subepithelial tumor(SET)and that was diagnosed by endoscopic ultrasound fine-needle biopsy(EUS-FNB).Malignant gastric lesions are rarely metastatic and the primary tumor is mainly breast,lung,esophageal cancer or cutaneous melanoma.Gastric metastasis from ovarian cancer is unusual,presenting synchronously with the primary tumor but also several years later than the initial diagnosis.From an endoscopic point of view,gastric metastasis does not present specific features.They may mimic both a primary gastric tumor or,less frequently,an SET.This case demonstrates the importance of EUS-FNB in distinguishing SETs and how this may alter treatment and prognosis.
文摘Diagnosis of gastric subepithelial tumor(SET) has shown a rapid increase worldwide.Although,until now,endoscopic ultrasound guided procedures such as fine needle aspiration have shown relatively high accuracy in diagnosis of SET,the most important modality for diagnosis and treatment of SETs is complete resection such as endoscopic or surgical resection.However,endoscopic resection or laparoscopic wedge resection alone also has some limitations.Endoscopic resection is difficult to perform in cases of gastric SET located within deep portion of the gastric layer or a relatively large(larger than 25 mm diameter).On the other hand,gastric SET in a difficult location,such as the gastroesophageal junction or pyloric ring is challenging for laparoscopic surgical resection.The hybrid natural orifice transluminal endoscopic surgery(NOTES) technique is a combined method,including the advantages of both laparoscopic resection and endoscopic resection for gastric SETs.This method may be performed safely with reasonable operation times,less bleeding,and adequate resection margin and regardless of tumor size.In particular,in the case of a difficult location for resection,such as the esophagogastric junction or pyloric ring,hybrid NOTES is currently believed to be an ideal treatment method.
基金Supported by the Engineering Training Funds in Shenzhen,No.SYLY201718,No.SYJY201714,and No.SYLY201801Technical Research and Development Project of Shenzhen,No.JCYC20170307100911479,No.JCYJ20190807145617113,No.JCYJ20210324113802006.
文摘BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resection techniques are time-consuming and lack efficacy for small SEL-MPs.AIM To evaluate the efficacy and safety of ligation-assisted endoscopic submucosal resection(ESMR-L)following unroofing technique for small esophageal SEL-MPs.METHODS From January 2021 to September 2023,17 patients diagnosed with esophageal SEL-MPs underwent ESMR-L following unroofing technique at the endoscopy center of Shenzhen People’s Hospital.Details of clinicopathological characteristics and clinical outcomes were collected and analyzed.RESULTS The mean age of the patients was 50.12±12.65 years.The mean size of the tumors was 7.47±2.83 mm and all cases achieved en bloc resection successfully.The average operation time was 12.2 minutes without any complications.Histopathology identified 2 Lesions(11.8%)as gastrointestinal stromal tumors at very low risk,12 Lesions(70.6%)as leiomyoma and 3 Lesions(17.6%)as smooth muscle proliferation.No recurrence was found during the mean follow-up duration of 14.18±9.62 months.CONCLUSION ESMR-L following roofing technique is an effective and safe technique for management of esophageal SEL-MPs smaller than 20 mm,but it cannot ensure en bloc resection and may require further treatment.
文摘Endoscopic ultrasound tissue acquisition,in the form of both fine needle aspiration(EUS-FNA)and fine needle biopsy(EUS-FNB),is utilized for pancreatic mass lesions,subepithelial lesions,and lymph node biopsy.Both procedures are safe and yield high diagnostic value.Despite its high diagnostic yield,EUS-FNA has potential limitations associated with cytological aspirations,including inability to determine histologic architecture,and a small quantitative sample for further immunohistochemical staining.EUS-FNB,with its larger core biopsy needle,was designed to overcome these potential limitations.However,it remains unclear which technique should be used and for which lesions.Comparative trials are plagued by heterogeneity at every stage of comparison;including variable needles used,and different definitions of endpoints,which therefore limit generalizability.Thus,we present a review of prospective trials,systematic reviews,and meta-analyses on studies examining EUS-FNA vs EUSFNB.Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic mass lesions,and yield conflicting results in terms of demonstrating the superiority of one method.However,consistent among trials is the potential for diagnosis with fewer passes,and a larger quantity of sample achieved for next generation sequencing.With regard to subepithelial lesions and lymph node biopsy,fewer prospective trials exist,and larger prospective studies are necessary.Based on the available literature,we would recommend EUS-FNB for peri-hepatic lymph nodes.
文摘AIM:To observe the changes in corneal subepithelial nerve fibers(CNFs)and Langerhans cells(LCs)in patients with type 2 diabetes using corneal laser confocal microscopy(CLCM).METHODS:A total of 60 patients(64 eyes),including 40 patients with type 2 diabetes(DM group)and 20 subjects without diabetes(control group)were included with CLCM.Neuron J plugin of Image J software were used for quantitative analysis of CNF length(CNFL),CNF density(CNFD),corneal nerve branch fiber density(CNBD),main branch length density,branch length density,corneal nerve fiber tortuosity(NT)score,and LCs density.An independent samples t-test to analyze the variability between the two groups was performed,and Pearson correlation analysis was used to analyze the relationships between CNF and multiple biochemical indicators in the DM group.The predictive power of CNF for type 2 diabetes was assessed using the receiver operating characteristic(ROC)curve.RESULTS:There were significant differences in the CNFL,CNFD,and main branch length density between two groups.The results of Pearson correlation analysis showed a significant negative correlation between CNFD and the duration of diabetes as well as triglyceride levels and total cholesterol,and a significant positive correlation between CNFD and serum albumin.In addition,the NT score showed a positive correlation and urea nitrogen,similar to the positive correlation observed between LC density and glycosylated hemoglobin(HbA1c)levels.CNFD showed the highest area under the curve(AUC of ROC)value,followed by main branch length density and CNFL.The AUC of the ROC curve under the logistic regression model also demonstrated good predictive values.The cut-off values of CNFD,CNFL,and main branch length density for diabetes showed 31.25,18.85,and 12.56,respectively.CONCLUSION:In patients with type 2 diabetes,there is a notable reduction in both CNFL and CNFD.These measurements can be influenced by various blood biochemical factors.However,the compromised nerve fibers can serve as valuable indicators for predicting the onset of type 2 diabetes and also as biomarkers for detecting diabetic neuropathy and its related complications.
文摘Dear Sir,Iam Yonca A.Akova,MD-from the Department of Ophthalmology,Bayindir Kavaklidere Hospital,Turkey.I wrote this letter to evaluate the efficacy of 0.05%topical cyclosporine A（CsA）eye drops（Restasis Allergan,Irvine,USA）in symptomatic patients with recurrent subepithelial infiltrates（SEIs）due to adenoviral keratoconjunctivitis following steroid eye drops tapering or discontinuation.
文摘AIM: To evaluate the diagnostic yield and safety of a modified technique for the histological diagnosis of subepithelial tumors (SETs). METHODS: A retrospective review of patients who underwent a modified technique for the histological diagnosis of gastric SETs, consisting of a mucosal incision with a fixed flexible snare (MIF) and deep-tissue biopsy under conventional endoscopic view, from January 2012 to January 2013 was performed. Eleven patients with gastric SETs 10-30 mm in diameter and originating from the third or fourth layer on endoscopic ultrasonography were included. RESULTS: The mean age was 59.8 (range, 45-76) years, and 5 patients were male. The mean size of the SETs was 21.8 (range, 11-30) mm. The number of biopsy specimens was 6.3 (range 5-8). The mean procedure time was 9.0 min (range, 4-17 min). The diagnostic yield of MIF biopsies was 90.9% (10/11). The histological diagnoses were leiomyoma (4/11, 36.4%), aberrant pancreas (3/11, 27.3%), gastrointestinal stromal tumors (2/11, 18.2%), an inflammatory fibrinoid tumor (1/11, 9.1%); one result was non-diagnostic (1/11, 9.1%). There were six mesenchymal tumors; the specimens obtained in each case were sufficient for an immunohistochemical diagnosis. There was no major bleeding, but one perforation occurred that was successfully controlled by endoscopic clipping. CONCLUSION: The MIF biopsy was simple to perform, safe, and required a shorter procedure time, with a high diagnostic yield for small SETs.
文摘Endoscopic ultrasonography is the most accurate procedure for the evaluation of subepithelial lesions. The finding of a homogeneous, hyperechoic, well-delimited lesion, originating from the third layer of the gastrointestinal tract(submucosa) suggests a benign tumor,generally lipoma. As other differential diagnoses have not been reported, echoendoscopists might not pursue a definitive pathological diagnosis or follow-up the patient. This case series aims to broaden the spectrum of differential diagnosis for duodenal hyperechoic third layer subepithelial lesions by providing four different and relevant pathologies with this echoendoscopic pattern.
基金Supported by National Natural Science Foundation of China,No. 81101061Sichuan Science and Technology Planning Project,China,No. 2017JY0074。
文摘BACKGROUND Rectal subepithelial lesions(SELs) are commonly seen in endoscopic examination, generally manifested as bumps with a smooth surface. Precise preoperative diagnoses for rectal SELs are difficult because abnormal tissues are not easily to be obtained by regular endoscopic forceps biopsy. Traditional guidance modalities of preoperative biopsy, including endoscopic ultrasound, computed tomography, and transabdominal ultrasound, are often unsatisfactory. An updated, safe, and effective biopsy guidance method is required. We herein report a new biopsy guidance modality—endorectal ultrasound(ERUS) combined with contrastenhanced ultrasound(CEUS).CASE SUMMARY A 32-year-old woman complained of a mass inside the rectovaginal space for 9 years, which became enlarged within 1 year. A rectal SEL detected by endoscopy was suspected to be a gastrointestinal stromal tumor or exophytic uterine fibroid. Pathological diagnosis was difficult because of unsuccessful transabdominal core needle biopsy with insufficient tissues, as well as vaginal hemorrhage. A second biopsy was suggested after multiple disciplinary treatment discussion, which referred to a transperineal core needle biopsy(CNB) guided by ERUS combined with CEUS. Adequate samples were procured and rectal gastrointestinal stromal tumor was proved to be the pathological diagnosis. Imatinib was recommended for first-line therapy by multiple disciplinary treatment discussion. After the tumor shrunk, resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall. Adjuvant therapy was applied and no recurrence or metastasis has been found by the last follow-up on December 13, 2019.CONCLUSION Transperineal CNB guided by ERUS and CEUS is a safe and effective preoperative biopsy of rectal SELs yet with some limitations.
文摘Management of subepithelial tumors(SETs) remains challenging. Endoscopic ultrasound(EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods.
