title: Endoscopic ultrasonography diagnosis of subepithelial lesions.
abstract: Using endoscopic ultrasonography (EUS), it is practicable to diagnose subepithelial lesions (SEL) with originating layer, echo level, and internal echo pattern etc. Lipoma, lymphangioma, and cyst have characteristic features; therefore, there is no need for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Ectopic pancreas and glomus tumors, which originate from the third and fourth layers, are frequently seen in the antrum. However, ectopic pancreas located in the fundus or body is large and originates from the third and fourth layers (thickening of fourth layer). Each subepithelial lesion has characteristic findings. However, imaging differentiation of tumors originating from the fourth layer is very difficult, even if contrast echo is used. Therefore, EUS-FNA should be done in these tumors, but the diagnostic yield for small lesions is not sufficient for clinical demands. Generally, those tumors, including small ones, should be first followed up in 6 months, then yearly follow up in cases of no significant change in size and features. When those tumors become larger than 1-2 cm, EUS-FNA is recommended. Furthermore, unusual SEL and SEL with malignant findings such as nodular, heterogeneous, anechoic area, and ulceration indicate EUS-FNA. Cap-attached forward-viewing echoendoscope is very helpful for EUS-FNA of small SEL.
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kida
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Yusuke
authors.identifier: http://orcid.org/0000-0003-2420-1176
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Miyata
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Rikiya
authors.initials: R
authors.lastname: Hasegawa
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamauchi
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Shuko
authors.initials: S
authors.lastname: Koizumi
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Okuwaki
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyazawa
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Iwai
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Kikuchi
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Maya
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaizumi
authors.affiliation: Department of Gastroenterology, Kitasato University, Sagamihara, Japan.
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
mesh_terms: D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D004848:Epithelium / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis*
keywords:  follow up; diagnosis; endoscopic ultrasonography; endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA); subepithelial lesion