Transabdominal Ultrasound for Visualizing Gastric Submucosal Tumors Diagnosed by Endosonography: Can Surveillance Be Simplified?

Background and Study Aims: Management options for gastric submucosal tumors (SMTs) include tumor removal or surveillance. If the latter is chosen, it requires repeated measurements of the tumor diameter. Although this can be achieved using endoscopy or endosonography (EUS), a less invasive and cheaper method would be welcome. The aim of this prospective study was to assess the proportion of gastric SMTs that can be visualized using transabdominal ultrasound of the water-filled stomach.
Patients and Methods: Fifty-one consecutive patients with endosonographically diagnosed gastric SMTs underwent transabdominal ultrasound examinations of the water-filled stomach performed immediately after EUS; both procedures were carried out by the same investigator. Transabdominal ultrasound was considered positive only if: firstly, the tumor was visualized unequivocally; secondly, its dimensions could be measured; and thirdly, photographic documentation could be recorded. In each case, a positive result had to be confirmed by an independent investigator, who reviewed the photographic documentation.
Results: The median size of SMTs on EUS was 25 mm (range 4 - 55 mm). Twelve tumors were located in the antrum, 25 in the gastric body, and 14 in the gastric fundus or cardia. Transabdominal ultrasound demonstrated the tumor in 35 of 51 patients (69 %). For tumors ≤ 30 mm, the visualization rate was 61 % (22 of 36). The location of the tumor and its EUS features did not significantly affect the sensitivity of transabdominal ultrasound.
Conclusions: In 69 % of patients with endosonographically diagnosed gastric SMTs, the tumor can also be visualized (and measured) using transabdominal ultrasound of the water-filled stomach. This noninvasive and inexpensive method may potentially be useful for surveillance in patients with SMTs, and further evaluation in this setting is warranted.

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