Eckardt Alexander J, Jenssen Christian
Department of Gastroenterology and Hepatology, DKD Helios Klinik Wiesbaden (Alexander J. Eckardt), Germany.
Department of Internal Medicine - Gastroenterology, Krankenhaus Märkisch Oderland, Strausberg-Wriezen (Christian Jenssen), Germany.
Ann Gastroenterol. 2015 Apr-Jun;28(2):160-172.
Subepithelial lesions (SEL) are identified during endoscopic procedures on a regular basis. They can occur anywhere in the gastrointestinal (GI) tract and are located beneath the normal epithelial layer, which explains why a tissue diagnosis is difficult to obtain with routine biopsies. Endoscopic ultrasound (EUS) is used to further characterize these lesions. EUS can distinguish intramural lesion from extramural compression. Furthermore, it allows allocation of intramural lesions to a specific layer of the GI wall and offers additional information as to whether a lesion could be benign or malignant. EUS also assists in choosing the optimal means of tissue acquisition. The choice of tissue acquisition is based on a number of factors, such as tumor size, EUS features, and location within the GI tract or within a specific layer of the GI wall. Furthermore, local expertise and patient factors should be considered when deciding whether tissue acquisition, surgical intervention or follow up is recommended. In this review we offer an EUS-guided approach to the evaluation of incidental SEL based on current evidence and point out areas of uncertainty, which explain why the proposed algorithmic approach may be optional rather than optimal.
上皮下病变（SEL）在内镜检查过程中经常被发现。它们可发生于胃肠道（GI）的任何部位，位于正常上皮层之下，这就解释了为什么通过常规活检难以获得组织诊断。内镜超声（EUS）用于进一步明确这些病变的特征。EUS可以区分壁内病变和壁外压迫。此外，它还能将壁内病变定位到GI壁的特定层次，并提供有关病变是良性还是恶性的额外信息。EUS还有助于选择最佳的组织获取方法。组织获取方法的选择基于多种因素，如肿瘤大小、EUS特征以及在胃肠道内或GI壁特定层次内的位置。此外，在决定是否建议进行组织获取、手术干预或随访时，应考虑当地的专业水平和患者因素。在本综述中，我们基于当前证据提供了一种EUS引导下评估偶然发现的SEL的方法，并指出了存在不确定性的领域，这也解释了为什么所提出的算法方法可能是可选的而非最佳的。
