Clinical impact of EUS-guided Trucut biopsy results on decision making for patients with gastric subepithelial tumors ≥2 cm in diameter

Background Preoperative pathologic diagnosis of a gastric subepithelial tumor (SET) may improve clinical decision making. However, the clinical impact of EUS-guided Trucut biopsy (EUS-TCB) data on decision making in patients with a gastric SET has not been assessed. Objective To evaluate the impact of EUS-TCB information on the clinical management of patients with a gastric SET. Design Retrospective review of prospectively collected data. Setting Tertiary referral center. Patients Sixty-five patients with gastric SETs 2 cm or larger in diameter. Intervention EUS-TCB. Main Outcome Measurements The number of patients for whom treatment plans were changed because of EUS-TCB results. Results Nine SETs were not punctured by the TCB needle because of technical problems, and we were unable to obtain adequate subepithelial tissue from 19 SETs. Treatment plans were changed for 18 of 65 patients (27.7%). The changes were avoiding unnecessary resection (7 benign SETs ≥3 cm in diameter), scheduling for definitive treatment (6 GI stromal tumors and 1 carcinoid tumor), and modifying the surgical field (3 large GI stromal tumors and 1 carcinoma). When we assessed treatment plans relative to tumor location, we found that avoiding unnecessary resection was associated with the presence of cardiac SETs. Limitations Retrospective study with a small number of patients. Conclusions EUS-TCB changed or influenced management decisions in 18 of 65 patients (27.7%) with gastric SETs. Patients could receive proper and tailored surgery, medical treatment, or surveillance according to size and location of SETs with EUS-TCB.