Characterization of subepithelial lesions of the stomach and esophagus by contrast-enhanced EUS: A retrospective study.

Authors:
Christian Pesenti
Christian Pesenti
Paoli-Calmettes Institute
France
Erwan BORIES
Erwan BORIES
Paoli-Calmettes Institute
Fabrice Caillol
Fabrice Caillol
Paoli-Calmettes Institute
Jean Philippe Ratone
Jean Philippe Ratone
Paoli-Calmettes Institute
Genevieve Monges
Genevieve Monges
Paoli-Calmettes Institute
France
Flora Poizat
Flora Poizat
Paoli-Calmettes Institute
Jean Luc Raoul
Jean Luc Raoul
Paoli-Calmettes Institute

Endosc Ultrasound 2019 Jan-Feb;8(1):43-49

Endoscopic Unit, Paoli Calmettes Institute, Marseille, France.

Background And Objectives: Subepithelial lesions (SELs) of the upper part of the digestive tract are rare, and it can be difficult to characterize them. Recently, contrast-enhanced endosonography (EUS) and elastometry have been reported as useful adjuncts to EUS and EUS-guided fine needle aspiration (EUS-FNA) in cases of pancreatic mass and lymph node involvement. The aim of this retrospective analysis was to evaluate whether contrast-enhanced EUS can discriminate benign submucosal lesions from malignant ones. We describe our retrospective experience using the contrast agent SonoVue (Bracco Imaging, Milan, Italy) in an attempt to increase the diagnostic yield.

Patients And Methods: Between May 2011 and September 2014, 14 patients (5 men, 9 women; median age 64 years, range 31-80 years) with SELs of the stomach or esophagus underwent EUS with SonoVue (low mechanical index). There were 3 esophageal lesions and 11 gastric lesions. Mean size of the lesions was 30 mm (range 11-50 mm). They were discovered after anemia (n = 5), dysphagia (n = 1), and pain (n = 4) and during follow-up for resected gastrointestinal stromal tumors (GISTs) (n = 1) and a standard upper gastrointestinal endoscopy (n = 3). On endoscopic sonograms, 10 of these lesions were hypoechoic and located in the fourth layer (muscularis), and 4 were in the second or third layer (mucosa and submucosa). Contrast enhancement was assessed in the early phase (after several seconds) and late phase (>30 seconds); a final diagnosis was made based on the findings of EUS-FNA using a 19-gauge ProCore (Cook Medical, Bloomington, IN) (n = 9) or 22-gauge FNA system (Cook Medical) (n = 1), the resected specimen (n = 3), or deep biopsy (n = 1). Different immunostaining was used in the pathologic studies (RNA was analyzed later using the C-kit, CD-117, CD-34, desmin, DOG-1, α-smooth actin, caldesmon, PS-100, and Ki-67 antibodies).

Results: Final diagnoses were leiomyoma (n = 4), GIST (n = 5), schwannoma (n = 1), inflammatory tumor of Helvig (n = 1), pancreas rest (n = 2), and fibrosis (n = 1). No complications occurred. All 5 GISTs showed enhancement in the early and late phases, whereas the 8 remaining lesions did not show any enhancement. Only 1 leiomyoma showed heterogeneous enhancement.

Limitations: The monocentric and retrospective study design and small number of patients.

Conclusions: In cases of SELs of the stomach or esophagus, SonoVue could be a complementary tool to endosonography to differentiate GISTs (early and clear enhancement) from other SELs (few or no enhancement), such as leiomyomas or pancreatic rest. These results are similar to those of the few, small studies published on this topic, but more studies with a larger number of patients are needed to confirm these findings.

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Source
http://dx.doi.org/10.4103/eus.eus_89_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400084PMC
September 2018
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