Efficacy of deep biopsy for subepithelial lesions in the upper gastrointestinal tract.
BACKGROUND
Accurate diagnosis of subepithelial lesions (SELs) in the gastrointestinal tract depends on a variety of methods: endoscopy, endoscopic ultrasound and different types of biopsy. Making an error-free diagnosis is vital for the subsequent application of an appropriate treatment.


OBJECTIVE
To evaluate the efficacy of deep biopsy via the endoscopic submucosal dissection (ESD) technique for SELs in the upper gastrointestinal tract.


METHODS
It was a case series study. Deep biopsy via the ESD technique was completed in 38 patients between November 2012 and October 2014. Thirty-eight SELs in the upper gastrointestinal tract of varying size (very small ≤ 1 cm, small 1-2 cm and large ≥ 2 cm) by means of the ESD technique after an incision with an electrosurgical knife of the overlying layers and revealing a small part of the lesion were biopsied under direct endoscopic view.


RESULTS
Deep biopsy via the ESD technique was diagnostic in 28 of 38 patients (73.3%; 95% CI: 59.7-89.7%). The diagnostic yield for SELs with a clear endophytic shape increased to 91.3%. An evident endophytic appearance of a subepithelial lesion, the mean number of biopsied samples (6.65 ±1.36) and the total size in length of all samples per case (19.88 ±8.07 mm) were the main criteria influencing the positiveness of deep biopsy in the diagnostic group compared to the nondiagnostic one (p = 0.001; p = 0.025; p = 0.008).


CONCLUSIONS
Deep biopsy via the ESD technique is an effective and safe method for the diagnosis of SELs especially with a clear endophytic appearance in a large number of biopsied samples.
Clinic of Gastroenterology, Nephrourology and Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santariskiu Klinikos, Centre of Hepatology, Gastroenterology and Dietetics, Vilnius, Lithuania.
Rolandas
R
Vaicekauskas
Clinic of Gastroenterology, Nephrourology and Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santariskiu Klinikos, Centre of Hepatology, Gastroenterology and Dietetics, Vilnius, Lithuania.
Juozas
J
Stanaitis
Clinic of Gastroenterology, Nephrourology and Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santariskiu Klinikos, Centre of Hepatology, Gastroenterology and Dietetics, Vilnius, Lithuania.
Jonas
J
Valantinas
deep biopsy; endoscopic submucosal dissection; gastrointestinal stromal tumor; subepithelial lesions