Management of Subepithelial Lesions (SEL) Encountered During Routine Endoscopy

Publication Date: July 12, 2022
Last Updated: July 25, 2022

Best Practice Advice

Forceps bite-on-bite or deep-well biopsies or tunnel biopsies can sometimes establish a pathologic diagnosis of SEL.

Endoscopic ultrasound (EUS) is the modality of choice to evaluate indeterminate SEL of the GI track and/or if non-diagnostic tissue by forceps biopsies.

SEL arising from the submucosa can be sampled using tunnel biopsies (or deep-well biopsies), EUS guided fine needle aspiration (FNA), EUS guided fine needle biopsy (FNB) or advanced endoscopic techniques (unroofing or endoscopic submucosal resection).

SEL arising from muscularis propria should be sampled (preferably using FNB or FNA) in order to determine if the lesion is a gastrointestinal stromal tumor (GIST) or leiomyoma. Structural assessment and staining will allow differentiation of mesenchymal tumors and assessing their malignant potential.

Recommendation Grading



Management of Subepithelial Lesions (SEL) Encountered During Routine Endoscopy

Authoring Organization

Publication Month/Year

July 12, 2022

Last Updated Month/Year

April 17, 2024

Document Type


Country of Publication


Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Hospital, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant




endoscopy, subepithelial lesions, SEL

Source Citation

Sharzehi K, Sethi A, Savides T. AGA Clinical Practice Update on Management of Subepithelial Lesions Encountered During Routine Endoscopy: Expert Review. Clin Gastroenterol Hepatol. 2022 Jul 13:S1542-3565(22)00640-1. doi: 10.1016/j.cgh.2022.05.054. Epub ahead of print. PMID: 35842117.