Brief Article
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World J Gastroenterol. Aug 7, 2013; 19(29): 4752-4757
Published online Aug 7, 2013. doi: 10.3748/wjg.v19.i29.4752
A feasible modified biopsy method for tissue diagnosis of gastric subepithelial tumors
Jung Ho Kim, Jun-Won Chung, Minsu Ha, Min Young Rim, Jong Joon Lee, Jungsuk An, Yoon Jae Kim, Kyoung Oh Kim, Kwang An Kwon, Dong Kyun Park, Yeon Suk Kim, Duck Joo Choi
Jung Ho Kim, Jun-Won Chung, Minsu Ha, Min Young Rim, Jong Joon Lee, Yoon Jae Kim, Kyoung Oh Kim, Kwang An Kwon, Dong Kyun Park, Yeon Suk Kim, Duck Joo Choi, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405-760, South Korea
Jungsuk An, Department of Pathology, Gachon University Gil Medical Center, Incheon 405-760, South Korea
Author contributions: Chung JW designed the research and performed procedure of modified biopsy; Kim JH and Ha M performed research; Rim MY, Lee JJ and Kim KO collected data; An J and Kim YJ analysed data; Kwon KA, Park DK and Kim YS coordinated and supported the statistical analysis; Kim JH wrote the paper; Choi DJ prepared the figures.
Correspondence to: Jun-Won Chung, MD, PhD, Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-Gu, Incheon 405-760, South Korea. drgreen@gilhospital.com
Telephone: +82-32-4603778 Fax: +82-32-4603408
Received: April 3, 2013
Revised: May 30, 2013
Accepted: June 8, 2013
Published online: August 7, 2013
Processing time: 124 Days and 13.8 Hours
Abstract

AIM: To evaluate the diagnostic yield and safety of a modified technique for the histological diagnosis of subepithelial tumors (SETs).

METHODS: A retrospective review of patients who underwent a modified technique for the histological diagnosis of gastric SETs, consisting of a mucosal incision with a fixed flexible snare (MIF) and deep-tissue biopsy under conventional endoscopic view, from January 2012 to January 2013 was performed. Eleven patients with gastric SETs 10-30 mm in diameter and originating from the third or fourth layer on endoscopic ultrasonography were included.

RESULTS: The mean age was 59.8 (range, 45-76) years, and 5 patients were male. The mean size of the SETs was 21.8 (range, 11-30) mm. The number of biopsy specimens was 6.3 (range 5-8). The mean procedure time was 9.0 min (range, 4-17 min). The diagnostic yield of MIF biopsies was 90.9% (10/11). The histological diagnoses were leiomyoma (4/11, 36.4%), aberrant pancreas (3/11, 27.3%), gastrointestinal stromal tumors (2/11, 18.2%), an inflammatory fibrinoid tumor (1/11, 9.1%); one result was non-diagnostic (1/11, 9.1%). There were six mesenchymal tumors; the specimens obtained in each case were sufficient for an immunohistochemical diagnosis. There was no major bleeding, but one perforation occurred that was successfully controlled by endoscopic clipping.

CONCLUSION: The MIF biopsy was simple to perform, safe, and required a shorter procedure time, with a high diagnostic yield for small SETs.

Keywords: Subepithelial tumors; Stomach; Biopsy; Endoscopy; Diagnostic techniques

Core tip: Tissue acquisition from subepithelial tumors (SETs) is essential for a differential diagnosis. Several techniques have been introduced to obtain SET tissue samples. However, the diagnostic efficacy was limited or the procedure was complex and difficult. We investigated a modified technique for the histological diagnosis of SETs, consisting of a mucosal incision with a fixed flexible snare (MIF) and deep-tissue biopsy at the incision site under a conventional endoscopic view. The results of this study suggest that the MIF biopsy is simple to perform, safe, fast, and provides a high diagnostic yield for small SETs.