The endoscopic diagnosis of gastric subepithelial lesions (SELs) relies primarily on gross features, including shape, color, surface characteristics, mobility, and size. However, endoscopic inspection alone is insufficient for a definitive diagnosis because SELs are covered by normal mucosa and originate from the deeper layers of the gastric wall. Recent guidelines from Korea, the United States, and Europe recommend endoscopic ultrasonography (EUS) to ascertain the lesion characteristics and layer of origin. The updated Korean guidelines recommend periodic endoscopic surveillance for asymptomatic lesions < 10 mm in size. In contrast, lesions ≥ 20 mm or those with highrisk features may warrant histologic confirmation, with tissue acquisition typically undertaken via mucosal incision-assisted biopsy (MIAB) and EUS-guided fine needle aspiration or biopsy (EUS-FNA/B). For lesions < 20 mm, MIAB demonstrates a superior diagnostic yield than EUS-FNA/B. The therapeutic options include endoscopic submucosal dissection, submucosal tunneling endoscopic resection, and endoscopic full-thickness resection. The treatment selection should be individualized based on lesion characteristics, operator expertise, and institutional resources to ensure safe and effective management.
Lee et al. (Mon,) studied this question.