JLE

Hépato-Gastro & Oncologie Digestive

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Role of endoscopic ultrasound for the diagnosis and management of subepithelial lesion of the digestive tract Volume 28, issue 9, November 2021

Video

  • Rôle de l’écho-endoscopie dans le diagnostic et la prise en charge des tumeurs sous-épithéliales digestives

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Tables

Authors
Hôpital Privé Jean-Mermoz, Service de gastro-entérologie, 55 avenue Jean Mermoz, 69008 Lyon
* Correspondance

The vast majority of digestive subepithelial lesions (SELs) are discovered incidentally during diagnostic endoscopic procedures. Endoscopic ultrasound (EUS) was demonstrated superior to others imaging techniques for the diagnosis of gastrointestinal (GI) SELs but remains suboptimal for differentiating lesions that arise from the muscularis propria (fourth digestive wall layer under EUS). EUS-guided tissue acquisition (EUS-TA) is the gold standard for the diagnosis of GI SELs, but can be technically challenging for small or near esophagogastric junction tumors. The diagnostic performance of biopsy needles for differentiating SELs and for adequately assessing the malignancy potential of GISTs is superior to that of aspiration needles (89.7% and 92% vs. 65% and 40%). Contrast harmonic EUS (CH-EUS) is an imaging technique, based on the study of tumor micro vascularization. Its performance has been demonstrated superior to standard B mode-EUS, for characterizing GI SELs and for pre-operative malignancy risk stratification of GISTs. New fields of application should be explored in the future for this technique, and particularly, in the evaluation of tumor response of GISTs to anti-angiogenic treatment.