title: Clinical characteristics, endosonographic findings and etiologies of gastroduodenal subepithelial lesions: a Thai referral single center study.
abstract: OBJECTIVE
  The present study was undertaken to evaluate the demographic data, endoscopic ultrasonography (EUS) characteristics of the sub-epithelial lesions, pathology results, complications and long-term follow-up of the patients whom referred for EUS evaluation at Siriraj Hospital.
  
  
  METHODS
  From January 2008-June 2011, a total of 61 cases was referred for EUS evaluation due to subepithelial lesions. The endoscopic reports, pathology results and the patients' medical records were reviewed. The present study was approved by Siriraj Institutional Review Board.
  
  
  RESULTS
  A total of 61 patients were referred for evaluation of subepithelial lesions, 6 of them were excluded. Thus, 55 cases were analyzed. The mean age was 57.7 +/- 13.8 years (27-87 years). Sixty seven percent were female. Only one-third of the patients had symptoms. The provisional diagnosis of the sub-epithelial lesions, regarding only clinical and endosonographic characteristics were GIST neuroendocrine tumor (NET), pancreatic rest, lipoma, granular cell tumor and others (70.9%, 9.1%, 9.1%, 3.6%, 3.6% and 3.6% respectively). All the lesions were diagnosed as GIST originating from either the forth layer (97.4%) or the second layer (2.6%) of gastric or duodenal wall. Fine needle aspiration (FNA) was performed in 13 patients (23.6%). The positive predictive value, negative predictive value and accuracy of diagnosis of GIST made by endosonographers based on only endosonographic characteristics were 85, 100 and 86% (95% CI: 62.4%-94.4%) respectively.
  
  
  CONCLUSIONS
  Most of the subepithelial lesions which were referred for EUS evaluation at Siriraj Hospital were GISTs. The diagnosis of GISTcan be accurately made by using the EUS based on only endosonographic characteristics. FNA should be done for the large sized GIST. For small sized GIST (< 3 cm), FNA might not be beneficial but a 1year interval follow-up with EUS is recommended.
authors.affiliation: Siriraj GI Endoscopy Center, Siriraj Hospital, Department of Internal Medicine, Faculty of Medicine, Mahidol University, Bangkok, Thailand. kaiyjr@gmail.com
authors.forename: Varayu
authors.initials: V
authors.lastname: Prachayakul
authors.forename: Pitulak
authors.initials: P
authors.lastname: Aswakul
authors.forename: Supot
authors.initials: S
authors.lastname: Pongprasobchai
authors.forename: Nonthalee
authors.initials: N
authors.lastname: Pausawasdi
authors.forename: Thawatchai
authors.initials: T
authors.lastname: Akaraviputh
authors.forename: Tassanee
authors.initials: T
authors.lastname: Sriprayoon
authors.forename: Asada
authors.initials: A
authors.lastname: Methasate
authors.forename: Udom
authors.initials: U
authors.lastname: Kachintorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013785:Thailand