Background and study aims: Adequate tissue acquisition for the diagnosis
of gastric submucosal masses (GSMs) has been challen
ging for
gastroenterologists. The use of standard biopsy forceps generally recovers
non-diagnostic overlying mucosa. Endoscopic ultrasound (EUS) with fine-needle
aspiration (FNA) provides a significant improvement, but is often still
inadequate for diagnosis. The aim of the current study was to assess the
efficacy of a novel jumbo biopsy unroofing technique (JUT) for tissue
acquisition in GSM.
Patients and methods: This prospective study recruited patients who were
referred for EUS for the evaluation of GSM between 2006 and 2009. All patients
underwent EUS with FNA when feasible followed by JUT. The primary outcome was
diagnostic yield of JUT.
Results: A total of 93 patients were enrolled, 72 of whom were included in
the investigation; 16 patients were excluded with no evidence of a submucosal
mass or extrinsic compression, and five patients were further excluded by
pathology confirming mucosal lesions. Of the 72 jumbo biopsies 66 (92%) provided
diagnostic tissue without significant complications and 42 (58%) had lesions
amenable to FNA. Although 34 of the 42 lesions were deemed adequate at the time
of on-site cytological evaluation, only 28 (67%) provided sufficient tissue for
final diagnosis. More importantly, only 37/72 (52%) of all patients had lesions
that required any further intervention.
Conclusions: Utilization of JUT is safe and effective for diagnosis of
GSM. The data suggest that the jumbo biopsy unroofing technique should be
considered as an initial diagnostic strategy for GSMs found during upper
endoscopy.
