Gastric subepithelial lesions as a complex clinical problem. Examples of the effectiveness of endoscopic ultrasound diagnostics
Year: 2026
Type: article
Abstract: Subepithelial lesions of the stomach include a group of diseases with different etiologies, without specific clinical symptoms, and pose a diagnostic problem due to their heterogeneous nature. As their name suggests, they arise under the mucosal layer, or from the muscularis mucosa, submucosa, or muscularis propria. Gastroduodenoscopy allows the detection of submucosal neoplasms of the gastrointestinal tract in 0.36–4 % of cases, while the stomach is the most frequent location of submucosal neoplasms (up to 60 %), so the main clinical problem is that conventional gastroscopy often does not allow determining from which layer of the wall the neoplasm originates, whether it is benign or has malignant potential, or whether surgical intervention is required. Currently, endoscopic ultrasonography (EUS) is the best tool for characterizing subepithelial lesions of the stomach and is the leading method for diagnosing submucosal tumors of the gastrointestinal tract, as it combines the capabilities of endoscopic visualization and high-frequency ultrasound. To choose further treatment tactics, it is important to determine from which layers the tumor originates, to what level it grows, and whether there is damage to regional lymph nodes. Endoscopic ultrasonography can answer these questions. The European Society of Gastrointestinal Endoscopy recommends EUS as the most informative method for diagnosing submucosal neoplasms to determine the features of subepithelial lesions of the esophagus, stomach, intestine, clarify the size, location, initial layer, echogenicity, shape and perform differential diagnosis of benign and malignant tumors (growth into adjacent layers or organs, damage to lymph nodes). The purpose of the work was to demonstrate the role of endoscopic ultrasound in the diagnosis of gastric subepithelial lesions. Subepithelial (submucosal) lesions of the stomach in most cases have an asymptomatic course and are often an incidental finding during esophagogastroduodenoscopy. Endoscopic ultrasonography is the method of choice for the comprehensive assessment of subepithelial gastric neoplasms, as it allows determining the layer of origin of the tumor, its size, echogenicity, internal structure, contours, degree of vascularization and relationship to surrounding tissues. Additional use of compression elastography, contrast-enhanced endoscopic ultrasonography and EUS-guided fine-needle biopsy using modern needles significantly increases the accuracy of morphological verification and stratification of the risk of malignancy. The article presents clinical cases of patients evaluated for suspected gastric subepithelial lesions at the State Institution “Institute of Gastroenterology of of the National Academy of Medical Sciences of Ukraine”. They demonstrate that the results of EUS directly influence the choice of treatment tactics. EUS confirmed the diagnosis of a gastric subepithelial lesion in both patients.
Source: GASTROENTEROLOGY
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214712656