Last updated January 31, 2023

Diagnosis and Management of Gastrointestinal Subepithelial Lesions

DIAGNOSIS OF SUBEPITHELIAL LESIONS

We suggest EUS be performed preferentially compared with endoscopy or contrast-enhanced cross-sectional imaging for the diagnosis of nonlipomatous SEL. (C, VL)
620

We do not recommend one type of echoendoscope (forward viewing vs oblique viewing) when evaluating SEL. (S, L)
620

We do not suggest bite-on-bite biopsies in the evaluation of SEL before EUS. (C, VL)
620

We suggest EUS with tissue acquisition to improve diagnostic accuracy in the identification of solid nonlipomatous SEL. (C, VL)
620

We suggest EUS fine-needle biopsy (FNB) alone or EUS fine-needle aspiration (FNA) with rapid on-site evaluation (ROSE) sampling of solid SEL compared with EUS-FNA without ROSE. (C, L)
620

We suggest using an unroofing technique when definitive diagnosis of a SEL is necessary and when EUS-FNA or FNB is nondiagnostic. (C, L)
620

TREATMENT OF SUBEPITHELIAL LESIONS

We suggest either submucosal tunneling endoscopic resection (STER) or surgical resection for the management of SEL originating from the muscularis propria layer of the esophagus and gastroesophageal junction when resection is necessary. (C, VL)
620

There is insufficient evidence to recommend surveillance vs resection of gastric GIST <2 cm in size. Owing to their malignant potential, we suggest resection of gastric GIST >2 cm and all nongastric GIST. (C, VL)
620

We suggest endoscopic mucosal resection (EMR) or ESD for the resection of type 1 gastric neuroendocrine tumors (gNETs). (C, VL)
620

We suggest ESD over EMR for the resection of low-grade, small type 3 gNETs without radiologic or EUS evidence of lymphadenopathy that do not undergo surgical resection. (C, VL)
620

We do not suggest one type of endoscopic therapy (EMR vs ESD) for the resection of small (<1 cm), low-grade rectal neuroendocrine tumors (NETs). (C, VL)
620

Recommendation Grading

Overview

Title

Diagnosis and Management of Gastrointestinal Subepithelial Lesions

Authoring Organization

Publication Month/Year

January 5, 2023

Document Type

Guideline

Country of Publication

US

Document Objectives

The purpose of this guideline is to aid clinicians with the decision-making process surrounding the diagnosis of SEL and to make management recommendations based on the latest available evidence.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Management

Diseases/Conditions (MeSH)

D000081483 - Squamous Intraepithelial Lesions

Keywords

subepithelial lesions, SEL

Source Citation

Jacobson BC, Bhatt A, Greer KB, Lee LS, Park WG, Sauer BG, Shami VM. ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions. Am J Gastroenterol. 2023 Jan 1;118(1):46-58. doi: 10.14309/ajg.0000000000002100. Epub 2022 Sep 6. PMID: 36602835.