Natural history of asymptomatic subepithelial lesions of the upper gastrointestinal tract: A multicenter study in Korea

초록

BACKGROUND Subepithelial lesions (SELs) of the upper gastrointestinal tract are frequently detected during routine endoscopy. To date, their natural history remains unclear, and evidence-based guidelines for their management are lacking. AIM To investigate the clinical course of asymptomatic SELs through a large-scale multicenter cohort. METHODS This multicenter study was conducted at seven university hospitals in South Korea. We retrospectively analyzed the clinical, endoscopic, endoscopic ultrasonography, computed tomography, and histological data of patients who were newly diagnosed with asymptomatic SELs between January and December 2011. RESULTS The study followed 2546 patients with SELs for >= 12 months (median follow-up duration: 74 months; range: 12-205 months). A >= 25% increase in lesion size was observed in 287 patients (11.3%), including increases of >= 5 mm in 145 (5.7%) patients and >= 10 mm in 44 (1.7%) patients. The 5-year cumulative risks of intervention and a >= 25% increase in size were 1% and 4%, respectively. The risk factors for lesion growth included younger age, larger baseline size, absence of rolling signs, mucosal erosion, and heterogeneous echogenicity. Notably, the presence of a rolling sign was protective. CONCLUSION The risk of significant lesion growth and intervention in small, asymptomatic SELs was low. These findings support conservative management and less intensive surveillance of SELs < 3 cm without high-risk features.

키워드