| Abstract [eng] |
A subepithelial lesion (SEL) is an area of an abnormal tissue of non-epithelial origin. It is a broad-based convex into an intestinal lumen or exterior, covered by normal-appearing mucosa. This pathology is rather infrequent, most commonly identified incidentally during upper endoscopy. Only in rare cases does this method, via biopsy, yield a precise evaluation of SEL aetiology - most often it fails. If such is a case, other diagnostic methods are to be applied: endoscopic ultrasound (EUS) primarily, radiological imaging and different types of biopsy, if necessary. SEL aetiology proves to be divergent. It comprises benign SELs, mesenchymal neoplasms with a malignant risk and malignant SELs. Therefore, an accurate analysis of the afore-mentioned SELs in view of subsequent methodology of their diagnostics, treatment and control is vital. The sources of reference suggest a number of algorithms and recommendations for SEL diagnostics and treatment, though the proof level of these commonly appear to be low. This naturally causes discussion on what the most efficient diagnoses are, how to differentiate them, how to perform biopsies and what optimal plan of treatment and control is to be recommended. The objective of this study is to improve the efficacy of endoscopic and endoscopic ultrasound (EUS) features, to identify new differential diagnoses of SELs and to specify the most precise prognostic gastrointestinal stromal tumour (GIST) index. On the basis of our findings and the score set, we have created a unique scoring system of GISTs and leiomyomas, which has suggested a cut-off value of a subepithelial lesion index and could be handy in the process of an efficient diagnosis of GIST specificity. We also applied renewed deep biopsy based on our methodology, as well as established the criteria that could result in its diagnostic efficacy. We have also clarified the possibility to evaluate the malignancy risk of GISTs. On the basis of our study results, we have created an original algorithm for SEL diagnostics and treatment. Having unified the management principles of this pathology, we will be able to further carry out scientific research and suggest novel and error-free recommendations. |
