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.
6731
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.
6731
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).
6731
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.
6731
Recommendation Grading
Overview
Title
Management of Subepithelial Lesions (SEL) Encountered During Routine Endoscopy
Authoring Organization
American Gastroenterological Association
Publication Month/Year
July 12, 2022
Last Updated Month/Year
April 17, 2024
Supplemental Implementation Tools
Document Type
Consensus
Country of Publication
US
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Hospital, Outpatient, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management
Keywords
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.