Endoscopic resection of gastrointestinal submucosal lesions: a comparison between strip biopsy and aspiration lumpectomy.
BACKGROUND
Endoscopic diagnosis and treatment of gastrointestinal submucosal lesions is still not established. We evaluated the clinical usefulness of two resection methods for submucosal lesions, using a "nonrandomized surgeon" design.


METHODS
The strip biopsy method was evaluated at Tenri Hospital and the aspiration lumpectomy method was used at Kyoto University Hospital. The inclusion criteria for selecting patients were endosonographic findings indicating a tumor location within the submucosa.


RESULTS
Seventy-seven patients were treated. The size of the specimens (mean +/- SEM) was 20.7 +/- 0.9 mm for the aspiration lumpectomy group and 14.0 +/- 0.8 mm for the strip biopsy group (p < 0.01). Aspiration lumpectomy was adequate for a definitive histologic diagnosis in 95% of the cases (36 of 38) as compared with 77% (30 to 39) of the cases treated by strip biopsy (p = 0.047). The eradication rate was 87% for the aspiration lumpectomy group, and 74% for the strip biopsy group (p = 0.274). The complication rate resulting from these procedures (hemorrhage, mean 5%) was acceptable. Repeated endoscopic examinations revealed no recurrence except for one lymphangioma.


CONCLUSIONS
Endoscopic resection, especially aspiration lumpectomy, provides a significant benefit for accurate final diagnosis and eradication of submucosal lesions.
First Department of Internal Medicine, Kyoto University, Japan.
T
T
Kajiyama
K
K
Hajiro
M
M
Sakai
K
K
Inoue
Y
Y
Konishi
H
H
Takakuwa
S
S
Ueda
M
M
Okuma
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001706:Biopsy / Q000379:methods; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D019160:Endosonography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D016896:Treatment Outcome