Sub-Epithelial Lesions in Esophagogastroduodenoscopies (EGD) and Endoscopic Ultrasound: Epidemiology and Analysis

Date of Award


Degree Type


Degree Name

Master of Science (MS)

First Advisor

Fred Goldstein PhD, FCP

Second Advisor

Robert J Barsotti, PhD

Third Advisor

Anand Kumar, MD, MPH


Introduction: Sub-epithelial upper gastrointestinal lesions range in severity from benign to malignant. Therefore, it is important to understand their prevalence in order to improve outcomes related to more aggressive tumor processes. It was previously reported in 1991 that the incidence rate of these neoplastic processes was 1 %. New retrospective data suggests that the incidence has been underreported. This study reviews retrospective (2007 to 2017) and prospective data in order to reevaluate the incidence rate of subepithelial upper GI neoplasms. Methods: Over 19,000 data points were examined retrospectively for evidence of upper GI neoplasm as per ICD-9 and ICD-10 codes. Tumor size and location were reviewed in addition to the diagnostic modality by which these data were collected (FNA or biopsy). This information was compared to patient demographics and analyzed to determine whether certain populations were at higher risk than others. Then, to validate the study, IO data points were collected prospectively and analyzed for the presence of sub-epithelial GI lesions. These data were also compared to patient demographics. All patients were consented prior to EGD, and information collected prospectively was secured in a IBP AA-compliant database and maintained until validation analysis was complete Results: Retrospective data analysis demonstrated that 1061 patients had various documented lesions on EGD, an incidence rate of 5.53% (Table I). Using a confidence interval of 95% and z-score of 1.96, it was determined that the lower confidence interval was -3.17 to an upper confidence interval of3.29 (-3.17,3.29,3.23). If unique lesions conducted on repeat EGD were included, the incidence rate was as high as 1414, or 7.37%. Of the patients who were found to have sub-epithelial upper GI lesions, 32.2% (342) were Black females, 25.7% (273) were White females, 16% (170) were White males, and 14.8% (157) were Black males (Figure 1). Prospective data were analyzed for 10 patients undergoing upper endoscopy. Of the patients included in the prospective arm of the study, one was Asian, three were Black, five were White, and one was Hispanic (Table 3). The age distribution was from 38 to 75 years old. Esophageal reflux was a presenting symptom for five patients (50% incidence), and dysphagia was a presenting symptom in three (30% incidence). Of the 10 patients examined, one was found to have an intraluminal benign neoplasm of duodenum; however, this was not a sub-epithelial lesion. Gastritis and duodenitis were found in five patients (50% incidence), and esophagitis was found in two (20% incidence). One patient had.a diaphragmatic hernia while another had esophageal varices (Table 4). Conclusions: Retrospective data analysis suggests a statistically significant increase in subepithelial GI lesion incidence when compared to data collected in 1991. Prospective data collected did not demonstrate any sub-epithelial lesions. However, several different presenting symptoms were identified and can be correlated to reason for EGD. Esophageal reflux was the presenting symptom for five out of 10 patients; however, esophagitis was present in only 20%. Ten patients were found to have gastritis and duodenitis on exam. Further prospective data need to be collected to correlate symptoms and epidemiology with the incidence of subepithelial lesions.

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