Evaluation and Management of Mucosal and Submucosal Lesions in the Foregut

  • Dino Beduya
  • Gulshan ParasherEmail author


Submucosal or, more appropriately, subepithelial lesions are occasionally seen during upper gastrointestinal endoscopy. A minority turn out to be structures outside the gut wall but most are true intramural lesions. A majority of these lesions are found incidentally and are asymptomatic. Examples of these lesions include malignant or potentially malignant tumors such as gastrointestinal stromal tumors (GISTs) and carcinoids as well as benign lesions (lipoma, duplication cyst, heterotopic pancreas). Diagnosis often cannot be made by endoscopy alone. Endoscopic ultrasound helps narrow the differential diagnosis of a subepithelial lesion based on echogenicity and layer of origin. It also allows for deeper tissue acquisition and evaluation for candidacy for endoscopic resection. Management including endoscopic resection, surgical resection, or surveillance depends on the presence of symptoms, size, and histology if obtained.


Submucosal tumor Subepithelial lesion Upper gastrointestinal endoscopy Endoscopic ultrasound Immunohistochemistry 

Supplementary material

Video 12.1

EUS of a gastric spindle cell neoplasm (MP4 116736 kb)


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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyUniversity of New Mexico School of MedicineAlbuquerqueUSA

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