Current Practices in Histological Diagnosis and Management of Asymptomatic Gastric Subepithelial Lesions: A Multicenter Survey in Korea

Abstract

Gastric subepithelial lesions (SELs) are elevated lesions covered by normal mucosa often detected during esophagogastroduodenoscopy. Because of its submucosal location, accurate diagnosis through biopsy is challenging. We conducted a nationwide survey to identify differences in clinical practices across healthcare institutions with varying medical resources in Korea. We surveyed gastroenterologists in Korea between September 2023 and February 2024 using email, text messages, and Quick Response codes. The survey collected comprehensive data on respondent demographics, clinical practices for histological diagnosis, treatment decisions based on lesion size, and perceptions regarding endoscopic resection, including lesion size and the key factors influencing the decision to consider endoscopic resection. The 341 respondents surveyed included 104 (30.4%), 66 (19.3%), and 171 (50.3%) primary, secondary, and tertiary healthcare institutions, respectively. Most endoscopists did not perform biopsies of SELs <1 cm (70.4%, 240/341). However, for SELs 2-3 cm in size, most patients in primary and secondary healthcare institutions were transferred (85.9%), and EUS-guided biopsies (40.4%) were performed in tertiary hospitals. Endoscopic resection of gastric SELs was mainly performed in tertiary institutions (32.8% vs. 4.1%, p<0.001), and 75.7% (258/341) of the respondents considered endoscopic resection applicable for lesions <3 cm. Clinical practices for the histological diagnosis and treatment of asymptomatic gastric SELs vary according to the lesion size and healthcare institution type. Specific guidelines for the management of gastric SELs considering their size, features, and institutions are required.