Gastric subepithelial lesion — ESEGH MCQ

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ModerateEndoscopyGastric subepithelial lesionESEGH

A 68-year-old woman has an incidental 25 mm gastric subepithelial lesion with intact overlying mucosa. Contrast-enhanced CT shows a well-circumscribed intramural gastric mass without lymphadenopathy or distant metastases. Standard endoscopic forceps biopsies are non-diagnostic. What is the most appropriate next diagnostic investigation?

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Correct answer: B — Endoscopic ultrasonography with fine-needle biopsy

The correct answer is endoscopic ultrasonography with fine-needle biopsy. EUS defines the lesion's wall layer of origin, echogenicity and adverse morphological features, while core tissue permits histological and immunohistochemical distinction between GIST and other mesenchymal lesions. ESGE recommends tissue diagnosis for suspected GISTs larger than 20 mm and supports EUS-FNB for subepithelial lesions of this size. PET-CT is not the initial diagnostic test for a localised, uncharacterised lesion, and MRI would not provide the required histology. Percutaneous biopsy is less appropriate when the mass can be safely accessed from the gastric lumen. Repeat standard forceps biopsies are unlikely to help because intact mucosa overlies a deeper lesion.

Reference: European Society of Gastrointestinal Endoscopy. Deprez PH et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: ESGE Guideline, recommendations 1–3. Endoscopy. 2022;54:412–429. https://www.esge.com/endoscopic-management-of-subepithelial-lesions-esge-guideline