The examination of gastric submucosal protruding lesions with endoscopic ultrasound (EUS)

Introduction: The submucosal lesions of the gastrointestinal tract are often discovered during gastroscopy as intact epithelium-covered or exulcerated alterations. They are detected either incidentally or as the cause of gastrointestinal bleeding. Biopsies taken from the surface of the mucosa do not provide meaningful assistance in the characterization of the lesions. Endoscopic ultrasonography (EUS)-guided fine needle aspiration cytology (FNA) has a key role in the diagnosis of theise tumors. Results: In 2013 and 2014, during the EUS examinations of the esophagus, stomach and duodenum, submucosal protruding lesions were described in 19 cases. The average age of the patients was 66.46 years. Gender distribution: female: 5 (26%), male: 14 (74%). The number of gastric lesions was 13 (68%). In the group of gastric lesions, due to histologically confirmed adenocarcinoma of the stomach FNA was not performed in two cases (15.3%). FNA was performed on 11 patients (84.6%). The overall results of the EUS-FNA were diagnostic, suggestive, and nondiagnostic in 6 (54.5%), 4 (36.4%), and 1 (9%) cases respectively. Distribution of cytological results: C1: 1 (9%), C2: 8 (72.7%), C3: 1 (9%) C5: 1 (9%). Gastrointestinal stromal tumor (GIST) had the greatest proportion of the diagnoses: 4 cases (36.4%). Each of the cases listed below had a single occurence (9% of the total): lipoma, pancreatic cyst, abscess, leiomyogen tumor, low-differentiated adenocarcinoma, lymphoma, metastasis in lymph node of ductal, and tubular adenocarcinoma. Conclusion: Our results correlate with the data we have found in the international literature. The endoscopic ultrasound is of paramount importance in the diagnosis of gastric submucosal lesions. We suggest that into the diagnostical algorithm of gastric submucosal lesions detected during routine gastroscopy, EUS should be introduced as the second step, with FNA (when necessary).