The Natural History of Gastrointestinal Subepithelial Tumors Arising From Muscularis Propria: An Endoscopic Ultrasound Survey

• Published in: Journal of clinical gastroenterology Vol. 43; no. 9; pp. 821 - 825
• Main Authors: Bruno, Mauro, Carucci, Patrizia, Repici, Alessandro, Pellicano, Rinaldo, Mezzabotta, Lavinia, Goss, Matteo, Magnolia, Maria Rita, Saracco, Giorgio Maria, Rizzetto, Mario, De Angelis, Claudio
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-10-2009; Lippincott Williams & Wilkins
• Subjects: Aged; Biological and medical sciences; Digestive System Surgical Procedures; Digestive system. Abdomen; Disease Progression; Endoscopy; Endosonography; Female; Gastric Mucosa - diagnostic imaging; Gastric Mucosa - surgery; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Stromal Tumors - diagnostic imaging; Gastrointestinal Stromal Tumors - surgery; Humans; Intestinal Mucosa - diagnostic imaging; Intestinal Mucosa - surgery; Intestinal Neoplasms - diagnostic imaging; Intestinal Neoplasms - surgery; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Prospective Studies; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Treatment Refusal; Tumors; Sonography; EUS; GIST; Endoscopic route; Endoscopic ultrasonography; Malignant tumor; Gastrointestinal; echoendoscopy; endoscopic ultrasound; Gastrointestinal stromal tumor; Survey; Echography; Gastroenterology; Digestive diseases; Endoscopy; Ultrasound; Muscularis; Cancer; Gastric disease
• ISSN: 0192-0790; 1539-2031
• DOI: 10.1097/MCG.0b013e31818f50b8

AIMThe majority of lesions originating from muscularis propria of stomach, duodenum, and colon are gastrointestinal stromal tumors (GISTs). Surgery is indicated when endosonographic criteria of malignancy are met, but little is known about the natural history of lesions with benign endosonographic features. Aim of this study was to evaluate the natural course of benign-appearing lesions originating from muscularis propria in organs where GISTs significantly overcome leiomyomas.
MATERIALS AND METHODSA total of 49 asymptomatic patients with hypoechoic lesions originating from the fourth layer of the gastrointestinal tract entered a follow-up program by means of endoscopic ultrasonography. All lesions were nonulcerated, <3 cm in maximal diameter, with regular margins, and cystic spaces of <3 mm.
RESULTSAfter a mean follow-up of 31±20.8 months and a median of 2 (range, 1 to 5) endosonographies/patient, no change in echostructure or dimensions was seen in 44 subjects whereas in 5, an increase of at least 25% in 1 diameter occurred. Surgical removal was proposed to all1 patient refused (she is still alive and symptom-free after 4 y), 3 of the 4 lesions removed proved to be GISTs with very low or low risk of malignancy and 1 lesion was classified as a glomus tumor with no malignant appearance.
CONCLUSIONSEven small and benign-appearing lesions from muscularis propria may increase in size over time but this increase cannot be considered as an index of malignancy. As most of these lesions are GISTs, a policy of surveillance is advisable.