Diagnostic Value of Endoscopic Ultrasound‐Guided Tissue Acquisition With Rapid On‐Site Evaluation in Small Gastric Subepithelial Lesions

TL;DR

This study shows that endoscopic ultrasound-guided tissue sampling with rapid on-site evaluation works well for small stomach lesions, providing accurate diagnoses similar to larger lesions.

Contribution

Demonstrates diagnostic accuracy of EUS-TA with ROSE for small gastric subepithelial lesions (<20 mm) is comparable to larger lesions.

Findings

Diagnostic accuracy for SELs <20 mm was 88%, comparable to 93.8% for SELs ≥20 mm.

GIST was the most common diagnosis in both small and large SEL groups.

More passes were needed for SELs <20 mm to obtain adequate samples.

Abstract

Gastric subepithelial lesions (SELs) measuring <20 mm without high‐risk features are typically managed with periodic surveillance, while surgical resection is recommended for gastrointestinal stromal tumors (GISTs) per the Japanese guideline. Recent advancements in endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) needles have improved tissue collection, but few studies have assessed the utility of EUS‐TA for SELs <20 mm. This study aimed to evaluate the usefulness of EUS‐TA for gastric SELs <20 mm.

We retrospectively analyzed patients who underwent EUS‐TA for SELs at Tonan Hospital between June 2012 and March 2025. Variables including needle type, number of passes, histological diagnosis, and diagnostic accuracy were compared between SELs <20 and ≥20 mm. Rapid On‐Site Evaluation (ROSE) was performed for all specimens.

A total of 163 patients were included: 50 with SELs <20 mm and 113 with SELs ≥20 mm. Median lesion size was 15.5 and 31.7 mm, respectively. The <20 mm group required more passes to obtain adequate samples (2.5 vs. 2.0, p = 0.03). GIST was the most common diagnosis in both groups, with no significant difference (56% vs. 61.9%). Fine needle biopsy did not significantly improve sample adequacy or diagnostic accuracy. Diagnostic accuracy for SELs <20 mm was comparable to that for SELs ≥20 mm (88% vs. 93.8%).

EUS‐TA with ROSE for gastric SELs <20 mm yields diagnostic accuracy comparable to that for SELs ≥20 mm. Given the high GIST prevalence in small SELs, EUS‐TA may be a valuable diagnostic strategy.

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