DOI QR코드

DOI QR Code

Clinical course of asymptomatic duodenal subepithelial lesions

  • Seokin Kang (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kwangbeom Park (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Do Hoon Kim (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yuri Kim (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hee Kyong Na (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeong Hoon Lee (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ji Yong Ahn (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kee Wook Jung (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kee Don Choi (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ho June Song (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Gin Hyug Lee (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hwoon-Yong Jung (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2023.08.25
  • Accepted : 2024.01.29
  • Published : 2024.07.01

Abstract

Background/Aims: There is limited knowledge regarding the management of duodenal subepithelial lesions (SELs) owing to a lack of understanding of their natural course. This study aimed to assess the natural course of asymptomatic duodenal SELs and provide management recommendations. Methods: Patients diagnosed with duodenal SELs and followed up for a minimum of 6 months were retrospectively investigated. Results: Among the 443,533 patients who underwent esophagogastroduodenoscopy between 2008 and 2020, duodenal SELs were identified in 0.39% (1,713 patients). Among them, 396 duodenal SELs were monitored for a median period of 72.5 months (interquartile range, 37.7-111.3 mo). Of them, 16 SELs (4.0%) showed substantial changes in size or morphology at a median follow-up of 35.1 months (interquartile range, 21.7-51.4 mo). Of these SELs with substantial changes, tissues of two SELs were acquired using endoscopic ultrasound-guided fine needle aspiration biopsy: one was a lipoma and the other was non-diagnostic. Three SELs were surgically or endoscopically removed; two were diagnosed as gastrointestinal stromal tumors, and one was a lipoma. An initial size of 20 mm or larger was associated with substantial changes during follow-up (p = 0.016). Conclusions: While the majority of duodenal SELs may not exhibit substantial interval changes, regular follow-up with endoscopy may be necessary for cases with an initial size of 20 mm or larger, considering a possibility of malignancy.

Keywords

References

  1. Papanikolaou IS, Triantafyllou K, Kourikou A, Rosch T. Endoscopic ultrasonography for gastric submucosal lesions. World J Gastrointest Endosc 2011;3:86-94.
  2. Sharzehi K, Sethi A, Savides T. AGA clinical practice update on management of subepithelial lesions encountered during routine endoscopy: expert review. Clin Gastroenterol Hepatol 2022;20:2435-2443.e4.
  3. Faulx AL, Kothari S, Acosta RD, et al. The role of endoscopy in subepithelial lesions of the GI tract. Gastrointest Endosc 2017;85:1117-1132.
  4. Cho JW; Korean ESD Study Group. Current guidelines in the management of upper gastrointestinal subepithelial tumors. Clin Endosc 2016;49:235-240.
  5. Deprez PH, Moons LMG, O'Toole D, et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022;54:412-429.
  6. Ko WJ, Song GW, Cho JY. Evaluation and endoscopic management of esophageal submucosal tumor. Clin Endosc 2017;50:250-253.
  7. Lim YJ, Son HJ, Lee JS, et al. Clinical course of subepithelial lesions detected on upper gastrointestinal endoscopy. World J Gastroenterol 2010;16:439-444.
  8. Kim TW, Kim GH, Park DY, et al. Endoscopic resection for duodenal subepithelial tumors: a single-center experience. Surg Endosc 2017;31:1936-1946.
  9. Granata A, Martino A, Zito FP, et al. Exposed endoscopic full-thickness resection for duodenal submucosal tumors: current status and future perspectives. World J Gastrointest Endosc 2022;14:77-84.
  10. Li C, Chu Y, Lv L, et al. Safety and efficacy of endoscopic resection for the treatment of duodenal subepithelial lesions. J Gastrointest Oncol 2021;12:856-863.
  11. Gill KR, Camellini L, Conigliaro R, et al. The natural history of upper gastrointestinal subepithelial tumors: a multicenter endoscopic ultrasound survey. J Clin Gastroenterol 2009;43:723-726.
  12. Bruno M, Carucci P, Repici A, et al. The natural history of gastrointestinal subepithelial tumors arising from muscularis propria: an endoscopic ultrasound survey. J Clin Gastroenterol 2009;43:821-825.
  13. Song JH, Kim SG, Chung SJ, Kang HY, Yang SY, Kim YS. Risk of progression for incidental small subepithelial tumors in the upper gastrointestinal tract. Endoscopy 2015;47:675-679.
  14. Kim D, Cho S, Park SY, et al. Natural course of asymptomatic upper gastrointestinal subepithelial lesion of 2 cm or less in size. J Clin Med 2022;11:7506.
  15. Landi B, Palazzo L. The role of endosonography in submucosal tumours. Best Pract Res Clin Gastroenterol 2009;23:679-701.
  16. Rosch T, Kapfer B, Will U, et al. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study. Scand J Gastroenterol 2002;37:856-862.
  17. Ji JS, Lee BI, Choi KY, et al. Diagnostic yield of tissue sampling using a bite-on-bite technique for incidental subepithelial lesions. Korean J Intern Med 2009;24:101-105.
  18. Dumonceau JM, Deprez PH, Jenssen C, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated January 2017. Endoscopy 2017;49:695-714.
  19. Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol 2018;24:2806-2817.
  20. Larghi A, Fuccio L, Chiarello G, et al. Fine-needle tissue acquisition from subepithelial lesions using a forward-viewing linear echoendoscope. Endoscopy 2014;46:39-45.
  21. Caglar E, Hatemi I, Atasoy D, Sisman G, Senturk H. Concordance of endoscopic ultrasonography-guided fine needle aspiration diagnosis with the final diagnosis in subepithelial lesions. Clin Endosc 2013;46:379-383.
  22. Jung YS, Lee H, Kim K, Sohn JH, Kim HJ, Park JH. Using forceps biopsy after small submucosal dissection in the diagnosis of gastric subepithelial tumors. J Korean Med Sci 2016;31:1768-1774.
  23. Lee M, Min BH, Lee H, et al. Feasibility and diagnostic yield of endoscopic ultrasonography-guided fine needle biopsy with a new core biopsy needle device in patients with gastric subepithelial tumors. Medicine (Baltimore) 2015;94:e1622.
  24. Han JP, Lee TH, Hong SJ, et al. EUS-guided FNA and FNB after on-site cytological evaluation in gastric subepithelial tumors. J Dig Dis 2016;17:582-587.
  25. Lee JH, Cho CJ, Park YS, et al. EUS-guided 22-gauge fine needle biopsy for the diagnosis of gastric subepithelial tumors larger than 2 cm. Scand J Gastroenterol 2016;51:486-493.
  26. Sepe PS, Moparty B, Pitman MB, Saltzman JR, Brugge WR. EUS-guided FNA for the diagnosis of GI stromal cell tumors: sensitivity and cytologic yield. Gastrointest Endosc 2009;70:254-261.
  27. Pih GY, Kim DH. Endoscopic ultrasound-guided fine needle aspiration and biopsy in gastrointestinal subepithelial tumors. Clin Endosc 2019;52:314-320.
  28. Borbath I, Pape UF, Deprez PH, et al. ENETS standardized (synoptic) reporting for endoscopy in neuroendocrine tumors. J Neuroendocrinol 2022;34:e13105.
  29. Exarchou K, Moore AR, Smart HL, Duckworth CA, Howes N, Pritchard DM. A "watch and wait" strategy involving regular endoscopic surveillance is safe for many patients with small, sporadic, grade 1, non-ampullary, non-functioning duodenal neuroendocrine tumours. Neuroendocrinology 2021;111:764-774.
  30. Panzuto F, Ramage J, Pritchard DM, et al. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for gastroduodenal neuroendocrine tumours (NETs) G1-G3. J Neuroendocrinol 2023;35:e13306.