Post written by Dean Ehrlich, MD, from the Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
This video showcases the bite-on-bite technique as an approach for the diagnosis and removal of gastric subepithelial lesions.
A patient was referred for evaluation of a gastric subepithelial lesion. Using the bite-on-bite technique with standard biopsy forceps and repeated biopsies, the lesion was systematically unroofed and removed. Visual inspection suggested a lipoma, which was confirmed on histopathology. The patient tolerated the procedure well without adverse events.
Gastric subepithelial lesions are common incidental findings on routine endoscopy. Endoscopic ultrasound is recommended for further evaluation of such lesions. Generally, fine-needle aspiration of the lesion is required for diagnosis, but the sample may be inadequate in small lesions. This video highlights a simple and safe technique that a community gastroenterologist can use to evaluate and manage these lesions, especially in the absence of an interventional endoscopist with expertise in endoscopic ultrasound.
The key to the bite-on-bite technique is performing repeated biopsies from the same location. One common mistake is taking biopsies from several locations within the lesion. Systematic biopsies from the same place will properly unroof the lesion, making it amenable for sampling and removal.
In this video, the subepithelial lesion was removed entirely. However, if the lesion is deep or large in size, then only a biopsy can be obtained for diagnosing the lesion.
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