Band and Biopsy: An Easier Way to Sample and Remove Small Subepithelial Lesions?
Vanessa M. Shami, MD, FASGE, reviewing Bas-Cutrina F, et al. Gastrointest Endosc 2023 May 30.
Diagnosis and resection of subcentimeter subepithelial tumors (SETs) can be challenging. One problem with endoscopic band ligation (EBL) and allowing the lesion to slough is the absence of pathology. However, EBL without resection combined with a single-incision needle-knife (SINK) biopsy may positively impact small gastrointestinal SET management. This multicenter, prospective, observational cohort study aimed to evaluate the feasibility of this strategy in small-sized SETs.
This multicenter study with 7 participating sites included 122 patients with SETs ≤15 mm, confirmed by endoscopic ultrasound (EUS) between March 2017 and March 2020. The mean age was 60.9 ± 13.2 years, the mean lesion size was 9 ± 2.8 mm, and 77% of the lesions were gastric in location.
The primary outcome was clinical success at 4 to 6 weeks, determined by complete SET disappearance on the next EUS image control, which occurred in 73.6% of patients (95% confidence interval [CI], 64.8-81.2). The secondary outcomes were 1-year clinical success, achieved in 68.4% of patients (95% CI, 59.1-76.8), and favorable clinical impact, achieved in 79.5% (95% CI, 71.3-86.3). Other secondary outcomes included diagnostic pathology, obtained in 62 of 93 SINKs performed (66.7%; 95% CI, 56.1%-76.1%) and procedure-related adverse events rate, which was 4.1% (95% CI, 1.3-9.3; all mild, n=2 bleeding, n=2 abdominal pain).
On multivariable analysis, a SET size of ≤10 mm was associated with a greater success rate (1-year, 87%; risk ratio [RR], 5.07; 95% CI, 2.63-9.8]) and clinical impact rate (92.7%; RR, 6.15; 95% CI, 2.72-13.93).
COMMENTEBL plus SINK-biopsy seems relatively easy and safe to perform; however, margin resection status is critical for malignant lesions and not obtained with this technique. Nevertheless, this technique is reasonable in likely benign and relatively small lesions, where resection margin status is less critical.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Bas-Cutrina F, Loras C, Pardo A, et al. Multicenter observational cohort study of endoscopic band ligation without resection of small-sized subepithelial tumours of the digestive tract (Banding-SET): a clinical protocol. Gastrointest Endosc 2023 May 30. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2023.05.057)
