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Endoscopic ultrasound for the characterization of subepithelial lesions of the upper gastrointestinal tract

Mary Lee Krinsky, DO
Kenneth F Binmoeller, MD, FASGE, FACG
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Kristen M Robson, MD, MBA, FACG


A subepithelial mass or a bulge encountered during an endoscopy can arise from within any layer of the gastrointestinal tract wall (intramural) or outside of the wall (extramural). They are usually found incidentally during endoscopy or routine imaging with barium contrast radiography, magnetic resonance imaging, or computed tomography. The differential diagnosis includes a number of benign and malignant nonepithelial tumors, intramural vessels, and extrinsic compression from extramural structures.

Endoscopy alone cannot accurately distinguish between intramural and extramural lesions [1]. By contrast, endoscopic ultrasonography can characterize such masses by identifying the layer of origin and guiding tissue acquisition for studies that include cytohistology, immunohistochemistry, and flow cytometry. The pathology combined with lesion size, location, and sonographic morphology can help distinguish between benign (the majority of subepithelial lesions) and malignant or premalignant lesions (algorithm 1).

This topic review will provide an overview of the most common subepithelial lesions that can be identified endosonographically. This discussion is generally consistent with society guidelines [2]. Further information on the individual lesions is also available:

(See "Epidemiology, classification, clinical presentation, prognostic features, and diagnostic work-up of gastrointestinal stromal tumors (GIST)".)

(See "Clinical characteristics of carcinoid tumors".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 13, 2017.
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