Endoscopic ultrasound-guided deep and large biopsy for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies

Figure 1 Endoscopic ultrasound characteristics of gastric infiltrating tumors. A: Invaded muscularis propria and the first three blurred sonographic layers; B: Invaded serosal layer; C: Ascites around gastric wall; D: Perigastric lymph node.

Figure 2 Endoscopic ultrasound-guided bite-on-bite technique. A and B: A gastric infiltrating tumor diagnosed by endoscopic ultrasound (EUS) (red arrow); C: Bite-on-bite technique performed after EUS localization; D: The bite is taken on top of the previous one to obtain valid tissue; E: Postoperative wound; F: Histology confirmed lymphoma (HE staining, × 400).

Figure 3 Endoscopic mucosal resection combined with bite-on-bite technique under the guidance of endoscopic ultrasound. A and B: A gastric infiltrating tumor diagnosed by endoscopic ultrasound (EUS); C: The thickest site was selected for biopsy after EUS localization (red arrow); D: The mucosa was then resected; E: Bite-on-bite technique was performed in the resection area; F: Histology confirmed adenocarcinoma with poor differentiation (HE staining × 400).