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Endoscopic characteristics and management of Subepithelial Lesions in Video-Gastascopie

Background: Subepithelial lesions (SELs) are incidental findings on endoscopies. Some have evil potential. Aim: Assess the prevalence, endoscopic characteristics, and diagnostic/therapeutic management of Sub-epithelial lesions (SELs) in video-gastroscopies (VGC). Materials and methods: All VGC for the period January 2011-June 2020 were included. Cases with missing data were excluded. Where a SELS was identified, the following was recorded: indication, age, sex, size, location and histology, findings from endoscopic ultrasonography (EUS), fine-needle aspiration (FNA), and surgical resection. Results: 55 SELS were evidenced in 7,983 patients (0.7%). 72% were women and the most common indication was dyspepsia (26%). The most frequent location was in the stomach (74%). The mean size was 16 mm (5-50 mm) and half were smaller than 10 mm. Seven presented ulcerated mucous, 4 were located in the gastric body and 86% were referred for gastrointestinal bleeding/anemia. In 26 cases of 55 (48%) standard biopsies were performed and in 6 of the 55 (11%) biopsies on biopsies, with no diagnostic yield. EUS was performed in 11% of them, all larger than 10 mm: 2 ectopic pancreases, 1 lesion compatible leiomyoma, 2 lesions of the muscularis propria (leiomyoma / GIST), and 1 extrinsic compression. No FNA was performed. All LSEs were managed conservatively. Conclusions: This is the first national study on the prevalence of SELS in the upper gastrointestinal tract and it was comparable to that of other series. The diagnostic yield of the biopsy was null. In most cases, the lesions were managed according to the recommendations of international guidelines.