title: Risk of progression for incidental small subepithelial tumors in the upper gastrointestinal tract.
abstract: OBJECTIVE
  Subepithelial tumor is a relatively common finding in upper gastrointestinal endoscopy. This study aimed to evaluate the natural course of incidentally detected small subepithelial tumors in the upper gastrointestinal tract and to analyze risk factors for increase in the size of such tumors.
  
  
  METHODS
  Medical records of 1684 patients with subepithelial tumors in the upper gastrointestinal tract incidentally detected between 2004 and 2013 were retrospectively reviewed. If serial follow-up endoscopy showed significant size increase, endoscopic or surgical resection was recommended because of possibility of malignant change.
  
  
  RESULTS
  954 participants with subepithelial tumors underwent serial upper gastrointestinal endoscopy for a period > 6 months. Initial mean size of subepithelial tumors was 8.7 mm (range 1 - 35 mm). During a mean follow-up of 47.3 months (range 6 - 118 months), lesion size was unchanged in 920 participants (96.4 %), and in 34 participants (3.6 %) lesions had increased at least 25 % in diameter (mean increment 6.2 mm, range 2 - 15 mm). Subepithelial tumors with overlying mucosal changes (hyperemia, erosion, or ulcer) had a significantly higher risk of increasing in size (odds ratio [OR] = 3.61, 95 % confidence interval [95 %CI] 1.06 - 12.28). Growth rates (size increment per year) for enlarging lesions were significantly correlated with initial size (r = 0.44, P = 0.009).
  
  
  CONCLUSIONS
  Most incidentally detected small subepithelial tumors in the upper gastrointestinal tract showed no size change during follow-up. Thus, regular follow-up with serial endoscopy may be sufficient for small subepithelial tumors (< 2 cm) with intact overlying mucosa.
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Song
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sang Gyun
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Hae Yeon
authors.initials: HY
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Kim
mesh_terms: D001706:Biopsy; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis*; D006801:Humans; D033162:Incidental Findings; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging / Q000473:pathology*