Published online Aug 7, 2013. doi: 10.3748/wjg.v19.i29.4752
Revised: May 30, 2013
Accepted: June 8, 2013
Published online: August 7, 2013
AIM: To evaluate the diagnostic yield and safety of a modified technique for the histological diagnosis of subepithelial tumors (SETs).
METHODS: A retrospective review of patients who underwent a modified technique for the histological diagnosis of gastric SETs, consisting of a mucosal incision with a fixed flexible snare (MIF) and deep-tissue biopsy under conventional endoscopic view, from January 2012 to January 2013 was performed. Eleven patients with gastric SETs 10-30 mm in diameter and originating from the third or fourth layer on endoscopic ultrasonography were included.
RESULTS: The mean age was 59.8 (range, 45-76) years, and 5 patients were male. The mean size of the SETs was 21.8 (range, 11-30) mm. The number of biopsy specimens was 6.3 (range 5-8). The mean procedure time was 9.0 min (range, 4-17 min). The diagnostic yield of MIF biopsies was 90.9% (10/11). The histological diagnoses were leiomyoma (4/11, 36.4%), aberrant pancreas (3/11, 27.3%), gastrointestinal stromal tumors (2/11, 18.2%), an inflammatory fibrinoid tumor (1/11, 9.1%); one result was non-diagnostic (1/11, 9.1%). There were six mesenchymal tumors; the specimens obtained in each case were sufficient for an immunohistochemical diagnosis. There was no major bleeding, but one perforation occurred that was successfully controlled by endoscopic clipping.
CONCLUSION: The MIF biopsy was simple to perform, safe, and required a shorter procedure time, with a high diagnostic yield for small SETs.
Core tip: Tissue acquisition from subepithelial tumors (SETs) is essential for a differential diagnosis. Several techniques have been introduced to obtain SET tissue samples. However, the diagnostic efficacy was limited or the procedure was complex and difficult. We investigated a modified technique for the histological diagnosis of SETs, consisting of a mucosal incision with a fixed flexible snare (MIF) and deep-tissue biopsy at the incision site under a conventional endoscopic view. The results of this study suggest that the MIF biopsy is simple to perform, safe, fast, and provides a high diagnostic yield for small SETs.