O34 Endoscopic ultrasound in diagnosis and follow-up of gastric sub-epithelial lesions: results from a regional centre

Introduction Gastric subepithelial lesions (SEL) have a broad differential including malignant disease. Endoscopic ultrasound (EUS) ± fine needle aspiration (FNA) has become essential in assessing and managing SELs. The optimum assessment and follow-up strategy for lesions 20 mm) of patients undergoing EUS for gastric SELs in our regional centre. Methods We undertook a retrospective analysis of our prospectively collected regional EUS database of patients who underwent EUS for SELs. Electronic patient records were analysed to obtain data including imaging, cytopathology and follow-up. Patients with SELs out-with the stomach and those undergoing investigation of known malignancy were excluded. Results 132 patients underwent EUS for an SEL identified on endoscopy (96.2%) or CT scan (3.8%). Mean age was 59 years with 31 (44%) male. 81 (64%) underwent endoscopic biopsy pre-EUS. Mean lesion size was 23.2 mm. All patients were followed up for a minimum of 12 months. 18 (13.6%), 58 (43.9%), and 54 (40.9%) lesions were 20 mm respectively. Three patients had EUS reported as normal/submucosal thickening only. 78 of the 81 biopsy results of SELs at initial endoscopy provided no diagnostic value. 47 (35.6%) patients underwent FNA of lesion, (0%,12% and 72% of patients for size 20 mm respectively). 5 (3.8%) SELs were not sampled due to patient factors. 27 (57%) of EUS-FNAs were diagnostic: 20 (42.5%) were proven GIST, 3 (6.3%) leiomyoma, 3 (6.3%) other malignancy and one lipoma. Only 2 (28%) FNAs of lesions All patients with SELs 20 mm, 17 had resection/Imatinib, 25 underwent surveillance and two died of other causes. Conclusion EUS is a useful tool in the assessment, diagnosis and follow-up of small SELs. Management of lesions