This study evaluated 107 patients with upper gastrointestinal submucosal tumors (SMTs) in Vietnam. Endoscopic biopsy by mucosal incision (EBMI) was performed on 47 SMTs over 10mm to obtain histological samples. The successful biopsy rate was 90% for esophagus and stomach tumors. Common histological findings included leiomyomas in the esophagus and gastrointestinal stromal tumors (GISTs) and leiomyomas in the stomach. No serious complications occurred. EBMI is shown to be an effective and low-cost alternative to EUS-FNA for obtaining samples from upper GI SMTs for pathological diagnosis.

1. Tuan K.V1, Giang D.A1, Hung T.V1, Truong N.M1, Viet T.T1, Muoi N.X1, Huong D.T.Q1,
Duong N.A1, Ngoc P.T.V1, Tuyen N.V2
Departments of Functional Examination1 and Pathology 2, Bach Mai National Hospital,
Hanoi, Vietnam.
CLINICAL, ENDOSCOPIC IMAGING AND THE VALUE
OF ENDOSCOPIC BIOPSY BY MUCOSAL INCISION FOR
UPPER GASTROINTESTINAL SUBMUCOSAL TUMOURS
1

2. Introduction
❖ Submucosal tumours (SMT) includes lesions in the
mucosal layer that grow under the epithelium.
❖ Malignancy risk: carcinoid tumors, lymphomas, glomus
tumors, and gastrointestinal stromal tumors (GISTs).
❖ Histological diagnosis is necessary
❖ EUS-FNAB is the standard method for taking biopsy for
histological diagnosis. However it is costly, requiring
material and skill.
✔ Su Young Kim et all 2016. SETs 10% - 30% have the potential to become malignant.
2

3. Introduction
❖ Endoscopic biopsy by mucosal incision (EBMI) is another
option for pathological diagnosis of SMT.
❖ This method has advantages such as lower cost, easy to do, not
requiring special equipment.
Method
❖ This prospective cohort study was conducted at Bach Mai
National hospital, Hanoi, Vietnam from 11/2014 to 7/2015.
3

4. Objectives
1. To identify clinical and endoscopic manifestation of
sub-mucosal tumors (SMTs) in upper
gastrointestinal tract.
2. To evaluate the effectiveness of endoscopic biopsy
by mucosal incision (EBMI) and describe
pathological characteristics of SMTs in upper
gastrointestinal tract.
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5. Intruments
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6. Result 1: Conventional endoscopy performance
● 107 patients with upper GI tract SMTs were included in this study
● SMTs were recognized: size, site, surface ( ulcer, bleeding...)
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7. 7
Female
Male
Result 1 (cont’)
Age: mean 47 (23 – 83)
Toru Okuzono et all, 2014: males 56%
& females 44%, mean age 60.1 yrs
Sato et al, 2005: nausea 63,8%, hemorrage 10,6% &
abdominal pain 8,5%.

8. 8
Result 1 (cont’)
EsophagusEsophagus (27%)
Stomach (58%)Duodenum (15%)
Tumor sites
Tumor sizes

9. Result 2: Endoscopic biopsy by mucosal incision*.
● EBMI were performed on 47 patients with SMTs > 10 mm
(Toru Okuzono et all, 2014: tumor size ≥ 15 mm)
● All the patients were performed EUS before EBMI
● EBMI method:
- Mucosal incision 5-10 mm were made on the surface of SMTs with pre-cut
needle knife.
- SMTs sample collected by biopsy forceps through the incision (at least 3
pieces).
- All the mucosal incisions were closed with hemoclip
- Biopsy samples tested histologically.
9*First described by Yokohata et al, 2007

10. Result 2 Successful rate
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Stomach
Esophagus
Toru Okuzono et all, 2014: successful rate for EBMI and
EUS-FNA reached 85% & 90% respectively.
So-Eun Park et al, 2015: successful rate for EBMI and
EUS-FNA reached 86.7%, 73.3%, correspondingly.
Mekky et al (2010), EUS-FNA : 62%

11. Result 2 (cont’)
Esophagus
Stomach
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Histological findings
Combined esophagus and stomach:
Toru Okuzono et all, 2014: GIST 67% &
leiomyoma19%
Combination
Stomach: Kawanowa K, 2006 & Abraham SC
et al, 2007: GIST ~ 50%

12. Result 2 (cont’)
• Neither delay hemorrage nor perforation after procedure
• Bleeding during procedure:
• Esophagus: 1/14 (7,1%)
• Stomach: 4/33BN (12,1%)
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Toru Okuzono et all, 2014: EBMI intra-procedural
bleeding 25.9%, while EUS-FNA 0%

13. 13
Case 1 (Vu Van L, M, 29 yrs)
Esophageal leiomyoma

14. 14
Case 2 (Nguyen thi X, F, 50 yrs)
GIST, CD34(+), CD117(+)

15. ➢ Majority of patients detected incidentally without specific symptoms
(91%).
➢ SMTs of upper GI tract mainly found on stomach (58%).
➢ Tumors sized < 10 mm accounts for around half in each of the three
locations.
➢ Successful rate of the biopsy method: 90% in combined groups
(esophagus and stomach)
➢ Pathology:
➢ Esophagus: leiomyoma (79%)
➢ Stomach: GIST (30%) and leiomyoma (24%)
➢ No serious complication were found in this study.
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Take home messages

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Disclosure conflict of interest
We do not have any conflict of interest in this research!
Bach Mai hospital
Ha Long Bay