Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5822
Peer-review started: March 21, 2021
First decision: April 29, 2021
Revised: May 10, 2021
Accepted: May 26, 2021
Article in press: May 26, 2021
Published online: July 26, 2021
Tissue acquisition from subepithelial lesions is often attempted by endoscopic ultrasound (EUS)-sampling as conventional endoscopic biopsy usually fails to reach deeper layers of the gastrointestinal wall.
To investigate the utilisation, safety and diagnostic yield of an intensified “bite-on-bite” tunnel biopsy technique.
In this retrospective cohort study, all patients presenting with subepithelial masses in the upper gastrointestinal tract from March 2013 to July 2019 were included. Data were analysed for size and location of the subepithelial mass, use of intensified tunnel biopsy protocol (more than 10 double bite-on-bite biopsies) or superficial conventional biopsies, histology and imaging results, occurrence of readmission and adverse events after endoscopy.
Two hundred and twenty-nine patients with subepithelial lesions were included. Superficial conventional biopsies were taken in 117 patients and were diagnostic only in one lipoma (0.9 %). Tunnel biopsies taken in 112/229 (48.9%) patients were significantly more likely to provide histological diagnosis (53.6%; P < 0.001). For lesions ≥ 10mm the diagnostic yield of tunnel biopsies further increased to 41/67 (61.2%). No immediate or delayed complications were reported. Only 8 of the 51 endoscopists (15.7%) regularly attempted tunnel biopsies.
Tunnel biopsy is a simple, safe and efficient but underutilised diagnostic modality for tissue acquisition in subepithelial masses. It should be routinely attempted at the initial endoscopy.
Core Tip: Subepithelal lesions are found relatively often on cross sectional imaging or during endoscopy. Conventional endoscopic biopsies will not reveal the histological diagnosis in most cases. Endoscopic ultrasound (EUS) with fine needle aspiration or biopsy allows the diagnosis in 50%-90% but requires specialist skills and equipment and is expensive. Tunnel biopsies taken in simple bite-on-bite technique allow histological diagnosis in more than 50% of subepithelial lesions. If tunnel biopsies are taken at the index endoscopy, further follow-up endoscopies and EUS investigations can be avoided in many cases.