A retrospective study of 408 endoscopic ultrasound (EUS) exams for submucosal lesions

BACKGROUND: The interobserver variability within this multicenter group has been reported for EUS exams of submucosal lesions (SL). A standardized review of EUS exams for SL at each center was done to facilitate prospective studies underway. METHODS: Data from past consecutive EUS exams for SL at 9 participating centers was recorded on standard survey forms for each exam & collated. RESULTS: 408 EUS exams of patients with SL were studied. Median Age = 58 yrs. (range 14-91). 57% were male. SL were located in the esophagus (26%), GE junction (2%), stomach (61 %), duodenum (9%) & colon (2%). EUS images suggested the SL to be a stromal tumor in 23%, an extramural structure or normal anatomy in 21%, vascular in 10%, a lipoma in 8%, & cystic in 6%. No immediate complications were reported. The EUS exam was completed in 402 (98%). Incomplete exams were due to technical failure in 4, 1 poor preparation, & 1 uncooperative patient. The recommendation of the endoscopist after EUS was for no further work up in 165 (40%), surgery was recommended for 58 (14%), a follow up CT for 9 (2%), a CT guided biopsy for 1 (.2%), & a follow up EUS for 93 (23%). A specimen was obtained via EGD with deep foceps biopsy, &/or FNA, &/or surgery in 150 (36%). Evaluation of these specimens revealed a conclusive diagnosis in 106/150 (73%). CONCLUSIONS: After an EUS evaluation a substantial number of patients with SL were advised not to pursue any further workup and therefore avoided the associated expenses and risks. EUS is a safe method for evaluating SL. Additional prospective studies are merited to determine if EUS is a cost effective method for evaluating SL.