Endoscopic ultrasound (EUS) appears to be more reliable than endoscopy in estimating the size of subepithelial gastric tumors (SETs), such as gastrointestinal stromal tumors (GIST), according to a recently published study in Surgical Endoscopy.

A significant percentage of SETs are malignant, including GISTs, lymphomas, and neuroendocrine tumors. Because these tumors are covered with normal mucosal tissue, it is often practice to make a diagnosis and an appropriate treatment plan even after performing a biopsy. Therefore, tumor size is 1 of the most important deciding factors in SET management, Hyungchul Park, of the University of Ulsan College of Medicine in Seoul, Republic of Korea, and colleagues noted.

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There need to be clear guidelines regarding a gold standard for SET size measuring, the authors noted. To this date, they are no studies comparing the accuracy or reliability of endoscopy and of endoscopic ultrasound, the researchers added.

“We aimed to investigate how we can most accurately determine SET size according to a method and SET by retrospectively analyzing surgically removed SETs,” the authors wrote.

The study included 190 patients who underwent surgery for a histopathologically confirmed SET and had documented endoscopic ultrasound and endoscopy. Tumor diameter was measured using a standard rule by a pathologist as a reference standard. SET size measurement reliability of each method compared to the reference standard was assessed using the intraclass correlation coefficient (ICC).

The most common histopathological variant among the included population was GIST, with over 80% of the sample, followed by schwannoma and leiomyoma, with 7% each. The mean SET diameter measured with a ruler was 3.5 cm compared to 3.1 cm by endoscopic ultrasound and 3.0 cm by endoscopy.

Endoscopic ultrasound was found to be highly reliable with an ICC of 0.86; endoscopic measurement, on the other hand, was classified as moderately reliable with an ICC of 0.75. 

However, a more profound analysis revealed endoscopy to be highly reliable in certain regions, such as the lower curvature, the middle third of the anterior wall, and the upper third of the posterior wall. Furthermore, endoscopic ultrasound appeared to be only moderately reliable in the lower third of the gastric chamber.

“When measuring the SET diameter by endoscopy, additional measurements with EUS should be considered for certain SET locations,” the authors concluded.


Park H, Ahn JY, Kim GH, et al. Reliability of endoscopic ultrasonography and endoscopy in measurement of gastric subepithelial tumor sizeSurg Endosc. Published online November 10, 2022. doi:10.1007/s00464-022-09276-w