title: Direct endoscopic biopsy for subepithelial tumor larger than 20 mm after removal of overlying mucosa.
abstract: OBJECTIVE
  An accurate diagnosis of a subepithelial tumor (SET) using endoscopic ultrasound (EUS) without tissue acquisition is difficult. Treatment plan for a SET may be influenced by endoscopic tissue diagnosis. We aimed to clarify the clinical outcomes of direct endoscopic biopsy for SET after removal of the overlying mucosa.
  
  
  METHODS
  We evaluated the medical records of 15 patients. All patients underwent direct endoscopic biopsy for a SET larger than 20 mm (involving proper muscle layer) after removal of the overlying mucosa. The rate of achieving an accurate diagnosis and the treatment decision after the procedure were evaluated.
  
  
  RESULTS
  The patients' mean age was 55.1 ± 14.7 years. The patient population predominantly comprised men (9/15, 60%). The mean tumor size was 24.3 ± 7.8 mm. The mean biopsy number was 3.5 ± 1.7. No major complications occurred with the procedure. The mean procedure time was 15 ± 7.4 min. An accurate diagnosis was achieved in 93.3% of patients (14/15). The main pathological diagnoses after direct endoscopic SET biopsy were leiomyoma (33.3%, 5/15) and ectopic pancreas (33.3%, 5/15) followed by gastrointestinal stromal tumor (GIST) (13.3%, 2/15) and schwannoma (13.3%, 2/15). The treatment plan was influenced by the result of biopsy in 80% of patients (9/15), and unnecessary surgical resection was avoided.
  
  
  CONCLUSIONS
  Direct endoscopic SET biopsy after removal of the overlying mucosa using an endoscopic conventional snare was a useful diagnostic tool with high diagnostic accuracy and low risk of complications.
authors.affiliation: a Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , Korea.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.affiliation: a Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , Korea.
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.affiliation: a Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.affiliation: a Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , Korea.
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.affiliation: a Department of Internal Medicine , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: b Department of Surgery , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , Korea.
authors.forename: Sun Hwi
authors.initials: SH
authors.lastname: Hwang
authors.affiliation: b Department of Surgery , Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan , Korea.
authors.forename: Si Hak
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D019160:Endosonography; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis* / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D007889:Leiomyoma / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Subepithelial tumor; biopsy; endoscopic ultrasound; gastrointestinal stromal tumor