Fact checked byHeather Biele

Read more

January 05, 2023
2 min read
Save

ACG guides diagnosis, management of subepithelial GI lesions with new recommendations

Fact checked byHeather Biele
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

The ACG has developed a clinical guideline to aid physicians in the diagnosis and management of patients with gastrointestinal subepithelial lesions, which recently was published in The American Journal of Gastroenterology.

Perspective from Amit Bhatt, MD

“The term subepithelial lesion (SEL) is used to describe a mass or mass-like structure that typically projects into the gastrointestinal lumen and arises from a non-mucosal layer within the GI tract wall,” Brian C. Jacobson, MD, MPH, FACG, director of program development for gastroenterology at Massachusetts General Hospital, and colleagues wrote. “SEL may be non-neoplastic, neoplastic but benign, neoplastic with malignant potential or malignant. When small, SEL rarely cause signs or symptoms and are typically incidental findings. However, depending on their location and size, some may cause symptoms such as dysphagia, overt or occult GI bleeding and chronic anemia.

HGI0123Jacobson_Graphic_01
Source: https://journals.lww.com/ajg/Fulltext/2023/01000/ACG_Clinical_Guideline__Diagnosis_and_Management.16.aspx?context=FeaturedArticles&collectionId=5

“Because the location of SEL typically precludes making a diagnosis through simple mucosal biopsies, they often present a diagnostic challenge.”

Although the diagnosis and management of SEL previously have been examined, specific diagnostic and treatment recommendations have not been formally evaluated.

Using the Grading of Recommendations Assessment, Development and Evaluation process, the ACG developed 11 “preferable approaches” to a typical patient with SEL based on currently published literature and expert review. Highlights include:

  • Compared with endoscopy or contrast-enhanced cross-sectional imaging, researchers suggest the use of endoscopic ultrasound for the diagnosis of nonlipomatous SEL.
  • Researchers do not recommend one specific type of echoendoscope (ie, forward viewing vs. oblique viewing) for evaluation.
  • EUS with tissue acquisition may improve diagnostic accuracy for the identification of solid nonlipomatous SEL.
  • Although there is insufficient evidence to recommend surveillance vs. resection of gastric gastrointestinal stromal tumors (GIST) smaller than 2 cm, GIST larger than 2 cm and all non-gastric GIST should undergo resection.
  • Researchers recommend endoscopic submucosal dissection over endoscopic mucosal resection for low-grade, small type 3 gastric neuroendocrine tumors without radiologic or EUS evidence of lymphadenopathy.
  • Researchers do not suggest one type of endoscopic therapy for the resection of small (< 1 cm), low-grade rectal neuroendocrine tumors.

“Future studies should clarify the role of primary resection vs. pre-resection diagnosis, whether there is a diagnostic role for artificial intelligence and directly compare endoscopic resection methods,” Jacobson and colleagues wrote. “Head-to-head comparisons of endoscopic vs. surgical resection techniques would better clarify their respective strengths and limitations and improve patient selection criteria.”

They continued, “As new endoscopic tools and devices become available, a standardized lexicon of terminology should be developed, and attention should be paid to their potential application in the management of SEL.”