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Reliability of endoscopic ultrasonography and endoscopy in measurement of gastric subepithelial tumor size

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Abstract

Background

Subepithelial tumor (SET) size is important in determining the treatment plan; however, size estimation for gastric SETs has not been well investigated. We aimed to investigate which method predicts SET size most accurately by retrospectively analyzing surgically removed SETs.

Methods

From January 2015 through June 2020, patients who underwent surgical gastric SET removal at Asan Medical Center, Seoul, Korea, were enrolled. SET sizes measured by pathologists and endoscopists were retrospectively reviewed. The reliability of SET size measurement by endoscopic ultrasonography (EUS) and endoscopy was calculated using intraclass correlation coefficient (ICC), with pathologic size as the gold standard.

Results

Overall, EUS was highly reliable (ICC 0.86, P < 0.001), and endoscopy was moderately reliable (ICC 0.75, P < 0.001). When analyzed according to SET location, endoscopy was highly reliable in the lesser curvature’s lower third (ICC 0.86, P = 0.014), middle third (ICC 0.88, P < 0.001), and upper third (ICC 0.90, P < 0.001); as well as the anterior wall’s middle third (0.84, P < 0.001) and the posterior wall’s upper third (ICC 0.80, P < 0.001). EUS (ICC 0.96, P = 0.005) and endoscopy (ICC 0.95, P = 0.008) both were most reliable for lower-third posterior wall lesions, whereas endoscopy was unreliable for middle-third greater curvature lesions (ICC 0.41, P = 0.05).

Conclusions

Both EUS and endoscopy were reliable methods for measuring gastric SET size, and overall, EUS was more reliable than endoscopy. In terms of SET location, EUS was consistently reliable, whereas endoscopy showed variable reliability. When measuring SET size by endoscopy, additional size measurements with EUS should be considered in certain locations.

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Funding

All authors declare that there was no financial support for the publication of this article.

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Authors and Affiliations

  1. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Hyungchul Park, Ji Yong Ahn, Hee Kyong Na, Kee Wook Jung, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee & Hwoon-Yong Jung

  2. Department of Gastroenterology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea

    Hyungchul Park

  3. Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea

    Ga Hee Kim

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  1. Hyungchul Park
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Contributions

HP: Conceptualization, Data curation, Formal analysis, Investigation, Writing – original draft, Writing – review & editing. JYA: Conceptualization, Supervision, Methodology, Project administration, Writing – review & editing. GHK, HKN, KWJ: Data curation, Manuscript review. JHL, DHK, KDC, HJS, GHL, H-YJ: Supervision, Manuscript review.

Corresponding author

Correspondence to Ji Yong Ahn.

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Disclosures

Hyungchul Park, Ji Yong Ahn, Ga Hee Kim, Hee Kyong Na, Kee Wook Jung, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung have no conflict of interest or financial ties to disclose.

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Park, H., Ahn, J.Y., Kim, G.H. et al. Reliability of endoscopic ultrasonography and endoscopy in measurement of gastric subepithelial tumor size. Surg Endosc 37, 2604–2610 (2023). https://doi.org/10.1007/s00464-022-09276-w

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