Superiority of mucosal incision-assisted biopsy over ultrasound-guided fine needle aspiration biopsy in diagnosing small gastric subepithelial lesions: a propensity score matching analysis

• Published in: BMC gastroenterology Vol. 20; no. 1; p. 19
• Main Authors: Minoda, Yosuke, Chinen, Takatoshi, Osoegawa, Takashi, Itaba, Soichi, Haraguchi, Kazuhiro, Akiho, Hirotada, Aso, Akira, Sumida, Yorinobu, Komori, Keishi, Ogino, Haruei, Ihara, Eikichi, Ogawa, Yoshihiro
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21-01-2020; BioMed Central; BMC
• Subjects: Biopsy; Comparative analysis; Diagnosis; Endoscopic ultrasonography; Endoscopy; Gastroenterology; Gastrointestinal cancer; Gastrointestinal tumors; Gastroscopy; Histology; Hospitals; Lesions; Medical records; Methods; Mucosa; Mucosal incision-assisted biopsy; Needle biopsy; Patients; Software; Subepithelial lesion; Success; Time; Tumors; Ultrasonic imaging; Ultrasound; Ultrasound-guided fine needle aspiration biopsy; Japan; United States > US; Germany; Subepithelial lesion; Mucosal incision-assisted biopsy; Ultrasound-guided fine needle aspiration biopsy
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-020-1170-2

Gastric subepithelial lesions, including gastrointestinal stromal tumors, are often found during routine gastroscopy. While endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) has been the gold standard for diagnosing gastric subepithelial lesions, alternative open biopsy procedures, such as mucosal incision-assisted biopsy (MIAB) has been reported useful. The aim of this study is to evaluate the efficacy of MIAB for the diagnosis of gastric SELs compared with EUS-FNAB.
We retrospectively analyzed medical records of 177 consecutive patients with gastric SELs who underwent either MIAB or EUS-FNAB at five hospitals in Japan between January 2010 and January 2018. Diagnostic yield, procedural time, and adverse event rates for the two procedures were evaluated before and after propensity-score matching.
No major procedure-related adverse events were observed in either group. Both procedures yielded highly-accurate diagnoses once large enough samples were obtained; however, such successful sampling was more often accomplished by MIAB than by EUS-FNAB, especially for small SELs. As a result, MIAB provided better diagnostic yields for SELs smaller than 20-mm diameter. The diagnostic yields of both procedures were comparable for SELs larger than 20-mm diameter; however, MIAB required significantly longer procedural time (approximately 13 min) compared with EUS-FNAB.
Although MIAB required longer procedural time, it outperformed EUS-FNAB when diagnosing gastric SELs smaller than 20-mm diameter.