Clinical course of asymptomatic duodenal subepithelial lesions

• Published in: The Korean journal of internal medicine Vol. 39; no. 4; pp. 603 - 611
• Main Authors: Kang, Seokin, Park, Kwangbeom, Kim, Do Hoon, Kim, Yuri, Lee, Jeong Hoon, Ahn, Ji Yong, Jung, Kee Wook, Choi, Kee Don, Song, Ho June, Lee, Gin Hyug, Jung, Hwoon-Yong
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Association of Internal Medicine 01.07.2024; The Korean Association of Internal Medicine; 대한내과학회
• Subjects: Adult; Aged; Asymptomatic Diseases; Disease Progression; Duodenal Diseases - pathology; Duodenal Diseases - surgery; Duodenal Neoplasms - pathology; Duodenal Neoplasms - surgery; duodenum; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endoscopy, Digestive System; endosonography; Female; gastrointestinal stromal tumors; Gastrointestinal Stromal Tumors - diagnostic imaging; Gastrointestinal Stromal Tumors - pathology; Gastrointestinal Stromal Tumors - surgery; Humans; Lipoma - diagnostic imaging; Lipoma - pathology; Lipoma - surgery; Male; Middle Aged; Original; Retrospective Studies; subepithelial lesions; Time Factors; 내과학; Gastrointestinal stromal tumors; Subepithelial lesions; Duodenum; Endosonography
• ISSN: 1226-3303; 2005-6648; 2005-6648
• DOI: 10.3904/kjim.2023.358

Background/Aims: There is limited knowledge regarding the management of duodenal subepithelial lesions (SELs) owing to a lack of understanding of their natural course. This study aimed to assess the natural course of asymptomatic duodenal SELs and provide management recommendations.Methods: Patients diagnosed with duodenal SELs and followed up for a minimum of 6 months were retrospectively investigated.Results: Among the 443,533 patients who underwent esophagogastroduodenoscopy between 2008 and 2020, duodenal SELs were identified in 0.39% (1,713 patients). Among them, 396 duodenal SELs were monitored for a median period of 72.5 months (interquartile range, 37.7–111.3 mo). Of them, 16 SELs (4.0%) showed substantial changes in size or morphology at a median follow-up of 35.1 months (interquartile range, 21.7–51.4 mo). Of these SELs with substantial changes, tissues of two SELs were acquired using endoscopic ultrasound-guided fine needle aspiration biopsy: one was a lipoma and the other was non-diagnostic. Three SELs were surgically or endoscopically removed; two were diagnosed as gastrointestinal stromal tumors, and one was a lipoma. An initial size of 20 mm or larger was associated with substantial changes during follow-up (p = 0.016).Conclusions: While the majority of duodenal SELs may not exhibit substantial interval changes, regular follow-up with endoscopy may be necessary for cases with an initial size of 20 mm or larger, considering a possibility of malignancy.