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Gastric subepithelial masses

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What are the causes of gastric subepithelial masses?

Gastric subepithelial masses are most commonly GIST.
Gastric lipomas are a rare cause of gastric subepithelial masses, accounting for <1% of gastric intramural lesions.

What are the clinical features of gastric subepithelial masses?

They are mostly diagnosed incidentally at endoscopy

Discuss the diagnostic approach to gastric subepithelial masses?

  • It is difficult to differentiate an intramural lesion from extramural compression with endoscopy alone.
  • On endoscopy, lipomas have a yellow hue and often exhibit a pillow sign when probed with closed biopsy forceps, and may also exhibit some mobility. A recent study showed that the pillow sign (indents when depressed using biopsy forceps) had 98% specificity but only 40% sensitivity in identifying lipomas.
  • Once a gastric subepithelial lesion is seen, an EUS is needed to define it further. A CT scan may also help to differentiate whether the lesion is intramural or extramural.

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