Malignant or Benign Subepithelial Tumors (Set) In The Upper Gastrointestinal Tract <20MM: Curative and Diagnostic Endoscopic Resection: Retrospective Study of 102 Patients

Aims Diagnosis of SET< 20mm in the upper part of gastrointestinal tract (UPGT) can be challenging. Accuracy of EUS-FNA is around of 46 % in case of SET < 20mm. To avoid long-term and coercing monitoring, endoscopic resection (ER) in case of suspicious malignant SET or in case of uncertain diagnosis was performed. The goal of this study was to confirm safety for ER for SET < 20mm.

Methods Single centre retrospective study. Patients who underwent a ER of SET in UPGT from 2007 to 2019 were included and divided in 2 groups: B-SET for for benign SET, M-SET for malignant SET.

Results One hundred and two patients (mean age = 60 years, 53 women) underwent ER for SER. Pre-therapeutic evaluation showed: mean size (EUS) of 16.9mm (+/-7.7), gastric localization in 67.5 %, and in the third layer in 55.9 %. ER indications were uncertain diagnosis in 90 % of the cases.

EMR was performed in 46 %, ESD in 31 %, hybrid resection in 23 % of the cases. Morbidity was 4 %. One bleeding needing hemostasis, and 2 perforations endoscopically managed. 82/102 SET were B-SET et 20 were M-SET. In 28/102 (27 %), a malignant lesion was wrongly suspected (including 2 false positives biopsies: 1 GIST, 1 lesion with low grade dysplasia). At the opposite, 2 M-SET was found after ER. An adjuvant treatment has been necessary for 4 M-SET. New ER for doubtful margin in 1 NET grade 1 and 1 GIST with low grade malignancy because of refusal of surgery; Two complementary surgery for 1 NET grade 2, and 1 GIST with intermediary risk. No relapse was reported for M-SET with a follow-up of 33 months (4-127) (mean GIST follow-up = 61 months; 17-127).

Conclusions ER of SET < 20mm allows a reliable diagnosis with very low morbidity. Follow-up for B-SET is avoided. ER for M-SET seems to be curative with a long-term follow-up.

Citation: Caillol F, Meunier E, Zemmour C et al. eP2 MALIGNANT OR BENIGN SUBEPITHELIAL TUMORS (SET) IN THE UPPER GASTROINTESTINAL TRACT <20MM: CURATIVE AND DIAGNOSTIC ENDOSCOPIC RESECTION: RETROSPECTIVE STUDY OF 102 PATIENTS. Endoscopy 2021; 53: S97.

Publication History

Article published online:
19 March 2021