In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features.
Consequently, definitive diagnosis usually requires tissue acquisition and pathologic confirmation.
Establishing a tissue diagnosis is difficult because the yield of forceps biopsies is low.
However, prospective data evaluating tissue sampling techniques for subepithelial lesions are currently lacking.
Dr Douglas Faigel and colleagues from Oregon prospectively determined the diagnostic yield of endoscopic submucosal-mucosal resection.
The research team then compared the diagnostic yield of the resection with forceps biopsy for lesions limited to the submucosa of the gastrointestinal tract.
Study patients were 23 adults with subepithelial lesions limited to the submucosa.
The researchers reported that all submucosal lesions underwent forceps biopsy followed by endoscopic submucosal resection.
Biopsy speciments were obtained with large-capacity ‘jumbo' forceps.
|The diagnostic yield of endoscopic submucosal-mucosal resection was 87%|
The team collected a total of 4 double passes from each lesion with use of the bite-on-bite technique.
Endoscopic resection was then performed with an electrosurgical snare or cap-fitted endoscopic mucosal resection device.
The researchers' main outcome measurement was the diagnostic yield of biopsy forceps compared with endoscopic submucosal resection.
The team identified 23 patients with lesions limited to the submucosa by endoscopic ultrasonography.
All lesions underwent forceps biopsy followed by endoscopic submucosal-mucosal resection.
The researchers found that the diagnostic yield of the jumbo forceps biopsy was 17%, whereas the diagnostic yield of endoscopic submucosal-mucosal resection was 87%.
Dr Faigel's team concludes, “In the evaluation of subepithelial lesions limited to the submucosa, endoscopic submucosal-mucosal resection has a significantly higher diagnostic yield than jumbo forceps biopsy with use of the bite-on-bite technique.”