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CC BY 4.0 · Endoscopy 2024; 56(S 01): E168-E170
DOI: 10.1055/a-2257-3279
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Contrast-enhanced endoscopic ultrasound-guided fine-needle aspiration for a gastric submucosal tumor with surrounding hemorrhage

Yuki Utakata
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
,
Takuji Iwashita 
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
,
Shota Iwata
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
,
Akihiko Senju
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
,
Ryuichi Tezuka
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
,
Shinya Uemura
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
,
Masahito Shimizu
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
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Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) represents a useful and less invasive procedure for procuring pathological specimens from lesions located either in proximity to or within the gastrointestinal wall [1] [2]. Contrast-enhanced EUS (CE-EUS) is known to be advantageous for differential diagnosis in various types of tumors, as it provides real-time blood flow images [3]. In this report, we present a patient with a gastric submucosal tumor associated with hemorrhage, in whom CE-EUS-guided FNA (CE-EUS-FNA) had a pivotal role in precisely identifying the lesion and facilitating accurate FNA.

A 60-year-old man initially presented with abdominal pain. A computed tomography scan revealed the presence of a tumor on the gastric wall, with possible perigastric hemorrhage ([Fig. 1]). Subsequently EUS-FNA was attempted on the gastric lesion, but EUS failed to detect the tumor because of the hemorrhage surrounding the stomach ([Fig. 2]). Consequently, CE-EUS was performed, enabling the identification of a 20-mm tumor that was contiguous with the gastric wall ([Fig. 3]). Subsequent CE-EUS-FNA using a 22-gauge fine-needle biopsy (FNB) needle was performed successfully and precisely ([Fig. 4]; [Video 1]). No adverse events related to the procedure were recognized.

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Fig. 1 Computed tomography image showing a tumor connected with the gastric wall, with possible perigastric hemorrhage.
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Fig. 2 Endoscopic ultrasound image showing that the tumor connected with the gastric wall could not be detected because of hemorrhage around the stomach.
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Fig. 3 Contrast-enhanced endoscopic ultrasound images showing the 20-mm tumor (arrows), which was connected with the gastric wall.
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Fig. 4 Contrast-enhanced endoscopic ultrasound images showing fine-needle biopsy (FNB), with a 22-gauge FNB needle, being successfully and accurately performed for the tumor.

Quality:
Contrast-enhanced endoscopic ultrasound-guided fine needle aspiration was performed for a submucosal tumor with surrounding hemorrhage.Video 1

Pathological examination of the obtained specimens revealed tumor cells characterized by spindle-shaped nuclei with positivity for c-kit and CD34 ([Fig. 5]). These findings were consistent with a diagnosis of gastrointestinal stromal tumor (GIST). Given the presence of intra-abdominal hemorrhage, surgical resection was undertaken following neoadjuvant therapy involving imatinib. The final pathological examination confirmed the diagnosis of a GIST.

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Fig. 5 Pathological appearance of the specimen showing tumor cells with spindle-shaped nuclei on hematoxylin and eosin (H&E) staining, and positivity on immunohistochemistry with c-kit (+) and CD34 (+), consistent with a diagnosis of gastrointestinal stromal tumor (GIST).

Recent studies regarding CE-EUS-FNA for pancreatic lesions have not conclusively demonstrated its superior diagnostic capabilities over B-mode-based EUS-FNA [4] [5]. In this case, however, CE-EUS enabled us to detect the tumor precisely and subsequently to perform precise needle puncture based on real-time perfusion imaging. CE-EUS-FNA could be useful in cases where lesion detection is interfered with by confounding factors such as hemorrhage.

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Publication History

Article published online:
15 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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