title: Compliance with surveillance recommendations for foregut subepithelial tumors is poor: results of a prospective multicenter study.
abstract: BACKGROUND
  American Gastroenterological Association guidelines recommend performing EUS to characterize subepithelial lesions (SELs) discovered on upper endoscopy (EGD), followed by surveillance if no high-risk features are identified. However, limited data are available on the impact of and compliance with surveillance recommendations.
  
  
  OBJECTIVE
  To determine the natural history of SELs<30 mm in size evaluated by EUS and to determine the degree of patient compliance with surveillance recommendations.
  
  
  METHODS
  Prospective registry.
  
  
  METHODS
  Two tertiary centers.
  
  
  METHODS
  We studied 187 consecutive adult patients referred for EUS evaluation of foregut SELs.
  
  
  METHODS
  Proportion of patients in whom SELs change in size or echo-features and compliance with follow-up recommendations.
  
  
  RESULTS
  Surveillance was recommended in 65 patients with hypoechoic SELs (44.6% women, age 59.5±13.2 years); of these, 29 (44.6%) underwent surveillance EUS as recommended and were followed for a median of 30 months (range, 12-105). During follow-up, 16 SELs (25%) increased in size, with a mean increase of 3.4±3.9 mm (range, 1-15). No changes in echo-texture of the SELs were observed. One patient was referred to surgery during follow-up (because of SEL growth>30 mm).
  
  
  CONCLUSIONS
  Short follow-up duration; compliance was a secondary aim.
  
  
  CONCLUSIONS
  During a median follow-up of 30 months, growth in size was observed in 25% of small foregut SELs. However, change in size was minimal, and only 1 patient was referred for surgery based on surveillance EUS findings. Compliance with surveillance recommendations is poor, with fewer than 50% of patients undergoing surveillance EUS as recommended.
authors: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors: Vladimir M
authors: VM
authors: Kushnir
authors: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Rajesh N
authors: RN
authors: Keswani
authors: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors: Thomas G
authors: TG
authors: Hollander
authors: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors: Cara
authors: C
authors: Kohlmeier
authors: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors: Daniel K
authors: DK
authors: Mullady
authors: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors: Riad R
authors: RR
authors: Azar
authors: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors: Faris M
authors: FM
authors: Murad
authors: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Srinadh
authors: S
authors: Komanduri
authors: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors: Steven A
authors: SA
authors: Edmundowicz
authors: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors: Dayna S
authors: DS
authors: Early
mesh_terms: D000368:Aged; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D017408:Guidelines as Topic; D006801:Humans; D033162:Incidental Findings; D007889:Leiomyoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012042:Registries; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery