Diagnosis and Management of Gastrointestinal Subepithelial Lesions
Publication Date: January 5, 2023
Last Updated: January 31, 2023
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
Title
Diagnosis and Management of Gastrointestinal Subepithelial Lesions
Authoring Organization
American College of Gastroenterology
Publication Month/Year
January 5, 2023
Last Updated Month/Year
February 13, 2024
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.