Introduction Submucosal lesions in the GI (gastro-intestinal) tract are difficult to diagnose. The diagnostic yield from mucosal biopsies using standard endoscopic forceps (bite-on-bite technique) and from EUS guided FNA is limited. Endoscopic submucosal dissection and surgery are high risk methods of tissue acquisition as the majority of these lesions are benign. Early diagnosis of a benign lesion will reduce the need for regular surveillance. In some instances, the diagnosis will also help in the endoscopic treatment of symptomatic benign lesions. We therefore evaluated the diagnostic yield achieved from mucosal incision-assisted biopsies of various submucosal lesions in a series of 10 patients.
Method A 20 month retrospective study of all patients who had mucosal incision-assisted biopsy of submucosal GI lesions. In case of upper GI lesions, EUS assessment preceded the needle knife mucosal incision. In lesions with a higher risk of bleeding, the defect was closed with clips. For all patients, we recorded the size, site and histopathological findings of the lesions and any procedure-related complications.
Results 10 submucosal lesions (size varying from 10–30 mm) were biopsied using prior mucosal incision between May 2013 and Dec 2014. Two were colonic, 3 duodenal, 2 in the stomach and 3 in the oesophagus. Adequate tissue for diagnosis was obtained in all except one small oesophageal lesion. Histological diagnosis and site is shown in the Table 1. One patient had delayed bleeding which settled following endoscopic treatment. There were no other complications, immediate or late.
Conclusion Mucosal incision-assisted biopsy is effective in the diagnosis of submucosal GI lesions with a high yield. It also appears safe. Although significant bleeding and perforation are possible complications, only one case of delayed bleeding, endoscopically treated, occurred in this series. Patients with asymptomatic benign lesions can be therefore be reassured with no need for further surveillance whilst appropriate treatment (endoscopic or surgical) can be rapidly arranged for malignant or symptomatic benign lesions.
Disclosure of interest None Declared.
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