Researchers reported that mucosal incision-assisted biopsy for the sampling of gastric subepithelial lesions is safe, with minimal impact on postoperative prognosis, as published in Surgical Endoscopy.

Gastrointestinal stromal tumors (GISTs) are the most common gastric subepithelial lesions. Because of the malignant potential of GISTs, it is important to distinguish them from other (benign) subepithelial lesions.

Standard treatment for obtaining a biopsy remains endoscopic ultrasound-guided fine-needle aspiration. Recently, mucosal incision-assisted biopsy has been developed due to its value in diagnosing gastric subepithelial lesions less than 20 mm in size. 

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“The short-term diagnostic performance of [mucosal incision-assisted biopsy] for gastric [subepithelial lesions] has been reported; however, it remains to be determined whether and, if at all, how [mucosal incision-assisted biopsy] affects the long-term subsequent clinical course in terms of the tumor’s dissemination risk,” the authors of the study wrote. 

The researchers hence conducted 2 studies to investigate the safety of this new biopsy technique. The first was a prospective observational study looking into whether tumor cells were present in gastric juices and if they were, whether the positive rate of tumor cells was terminated via mucosal incision-assisted biopsy.

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They enrolled 44 consecutive patients who had subepithelial lesions and had either undergone an endoscopic ultrasound-guided fine-needle aspiration (n=19) or a mucosal incision-assisted biopsy (n=25). 

The second study involved the retrospective analysis of the impact of mucosal incision-assisted biopsy on postoperative prognosis. The researchers analyzed a total of 107 patients with GISTs who were postoperatively managed according to Japanese guidelines. Among the 107 patients, 68 had an endoscopic ultrasound-guided fine-needle aspiration and 39 had a mucosal incision-assisted biopsy.

The results of both studies allowed the research team to reach the conclusion that the postoperative prognosis of patients with GIST who underwent mucosal incision-assisted biopsy was comparable to those who underwent endoscopic ultrasound-guided fine-needle aspiration; in other words, mucosal incision-assisted biopsy provided long-term safety.

“[Mucosal incision-assisted biopsy] is a safe procedure with little impact on postoperative prognosis,” the authors concluded.


Minoda Y, Ihara E, Itaba S, et al. Negligible procedure-related dissemination risk of mucosal incision-assisted biopsy for gastrointestinal stromal tumors versus endoscopic ultrasound-guided fine-needle aspiration/biopsySurg Endosc. Published online July 15, 2022. doi:10.1007/s00464-022-09419-z