Original Article
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Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study
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Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim, The Research Group for Endoscopic Ultrasound in Korean Society of Gastrointestinal Endoscopy
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Clin Endosc 2023;56(6):744-753. Published online August 25, 2023
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DOI: https://doi.org/10.5946/ce.2023.005
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Graphical Abstract
Abstract
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- Background
/Aims: This study aimed to evaluate the prevalence and natural progression of subepithelial lesions (SELs) in the upper gastrointestinal (UGI) tract.
Methods
The medical records of patients with UGI SELs who underwent endoscopic screening at eight university hospitals between January and December 2010 were retrospectively investigated. The follow-up evaluations were performed until December 2016.
Results
UGI SELs were found in 1,044 of the 65,233 participants screened (endoscopic prevalence, 1.60%; the total number of lesions, 1,062; mean age, 55.1±11.2 years; men, 53.6%). The median follow-up period was 48 (range, 8–74) months. SELs were most frequently found in the stomach (63.8%) and had a mean size of 9.9±6.1 mm. Endoscopic ultrasonography (EUS) was performed in 293 patients (28.1%). The most common lesions were leiomyomas, followed by gastrointestinal stromal tumors (GISTs), and ectopic pancreas. The proportions of SELs with malignant potential according to size were 3% (<1 cm), 22% (1–2 cm), 27% (2–3 cm), and 38% (≥3 cm). In gastric SELs larger than 1 cm, resections were performed in 20 patients because of an increase in size, of which 12 were found to be GISTs.
Conclusions
The prevalence of UGI SELs was 1.60%. Further, 23% of gastric SELs ≥1 cm were precancerous lesions, most followed by EUS and clinical decisions without initial pathological confirmation.
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Citations
Citations to this article as recorded by

- Endoscopic Diagnosis of Gastric Subepithelial Lesions < 20 mm: Current Strategies and Emerging Solutions
Yosuke Minoda, Shuzaburo Nagatomo, Haruei Ogino, Nao Fujimori, Eikichi Ihara
Digestive Endoscopy.2026;[Epub] CrossRef - Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Diagnosing Gastric Subepithelial Tumors
Moon Won Lee, Dong Chan Joo, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon
Diagnostics.2026; 16(1): 165. CrossRef - Prevalence of potentially malignant lesions in small gastric subepithelial lesions undergoing surgical resection according to the risk features
Sung Eun Kim, Mi Ran Jung
Foregut Surgery.2026; 6(1): 18. CrossRef - Recent advancement in size measurement during endoscopy
Hye Kyung Jeon, Gwang Ha Kim
Clinical Endoscopy.2026; 59(1): 1. CrossRef - Endoscopic and Hybrid Approaches for Gastric Subepithelial Tumors: Expanding the Frontiers of Minimally Invasive Therapy
Francesco Bombaci, Angelo Bruni, Michele Dota, Massimo Del Gaudio, Giuseppe Dell’Anna, Francesco Vito Mandarino, Francesco Azzolini, Emanuele Sinagra, Lorenzo Fuccio, Rocco Maurizio Zagari, Giovanni Barbara, Paolo Cecinato
Gastroenterology Insights.2026; 17(1): 13. CrossRef - The efficacy and safety of submucosal tunneling endoscopic resection in treating large esophageal subepithelial lesions
Huiting Lin, Songfeng Chen, Niandi Tan, Qianjun Zhuang, Xingyu Jia, Dianxuan Jiang, Yinglian Xiao, Jinhui Wang
Surgical Endoscopy.2025; 39(3): 1672. CrossRef - Natural Course and Long-Term Outcomes of Gastric Subepithelial Lesions: A Systematic Review
Masaya Iwamuro, Hiroyuki Okada, Motoyuki Otsuka
Journal of Clinical Medicine.2025; 14(4): 1055. CrossRef - Rapidly Growing Gastrointestinal Stromal Tumor on the Esophagus
Ji Hye Park, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(1): 64. CrossRef - Advancements in Endoscopic Treatment for Gastric Subepithelial Tumors
Osamu Goto, Kazutoshi Higuchi, Eriko Koizumi, Katsuhiko Iwakiri
Gut and Liver.2025; 19(2): 151. CrossRef - Endoscopic mucosal resection of a large duodenal polyp
Ye Rin Chae, Ga Hee Kim
Clinical Endoscopy.2025; 58(2): 331. CrossRef - Diagnostic accuracy and influencing factors of microprobe endoscopic ultrasound for gastrointestinal subepithelial lesions: a multicenter retrospective study
Jiao Li, Yongfeng Yan, Dandan Jiang, Xiaoxiang Wang, Li Wang, Li Liu, Tao Shu, Zhengkui Zhou, Xiaobin Sun
BMC Gastroenterology.2025;[Epub] CrossRef - Natural History of Gastric Subepithelial Tumors: Long-Term Outcomes and Surveillance Strategies
Hye Kyung Jeon, Gwang Ha Kim
Journal of Clinical Medicine.2025; 14(18): 6354. CrossRef - Natural Course of Gastric Subepithelial Tumors
Ji Yoon Kim, Seung Joo Kang
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(3): 224. CrossRef - Approach to Gastric Subepithelial Lesions: From Differential Diagnosis to Histologic Confirmation
Sang Hoon Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(3): 209. CrossRef - Gastric cancer with lymphoid stroma mimicking a subepithelial lesion after a 10-year disease-free interval: a case report
Bang Ju Kim, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee, Jung Wook Lee, Kyung Won Seo, Hee-Kyung Chang
Kosin Medical Journal.2025; 40(3): 233. CrossRef - Outcomes of device assisted endoscopic full thickness resection in gastroduodenal submucosal lesions: A large, multicentre study (with videos)
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Digestive and Liver Disease.2025; 57(12): 2435. CrossRef - Assessing the utility of three-dimensional imaging for preoperative assessment of gastric subepithelial tumors
Dong Chan Joo, Gwang Ha Kim
Clinical Endoscopy.2025; 58(6): 854. CrossRef - A Case of Esophageal MALT Lymphoma Mimicking a Subepithelial Tumor
Ha Eun Lee, Gwang Ha Kim, Min Ji Kim, Kyung Bin Kim, Dong Chan Joo, Hye Kyung Jeon, Moon Won Lee, Bong Eun Lee
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Tanyaporn Chantarojanasiri, Nikhil Sonthalia, Rashid N. Lui
Journal of Gastroenterology and Hepatology.2024; 39(7): 1207. CrossRef - Endoscopic treatment of a large Brunner’s gland hamartoma in the duodenum
Ha Eun Lee, Gwang Ha Kim, Kyungbin Kim
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Dong Chan Joo, Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Ji Woo Kim, Kwang Baek Kim
Journal of Clinical Medicine.2024; 13(13): 3725. CrossRef - An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
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Review
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Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE)
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Moon Jae Chung, Se Woo Park, Seong-Hun Kim, Chang Min Cho, Jun-Ho Choi, Eun Kwang Choi, Tae Hoon Lee, Eunae Cho, Jun Kyu Lee, Tae Jun Song, Jae Min Lee, Jun Hyuk Son, Jin Suk Park, Chi Hyuk Oh, Dong-Ah Park, Jeong-Sik Byeon, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun, Ho Soon Choi, Chan Guk Park, Joo Young Cho
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Clin Endosc 2021;54(2):161-181. Published online March 24, 2021
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DOI: https://doi.org/10.5946/ce.2021.069
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- Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in 8 categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.
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Citations
Citations to this article as recorded by

- An optimal curriculum for training in endoscopic ultrasound: a summarized evidence-based literature systematic review
Julieta Montanelli, Ariosto Honorio Hernandez Lara, Ana Karla Uribe Rivera, Juan Manuel Verde, Eike Burmester, Mohammad A. Al-Haddad, Stephan Hollerbach, Peter Vilmann, Monder Abu-Suboh Abadia, Abdenor Badaoui, Paolo Giorgio Arcidiacono, Christoph Schlag,
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Hao-Che Chang, Ping-Huei Tseng, Li-Chun Chang
Clinical Endoscopy.2025; 58(6): 859. CrossRef - Role of Endoscopic Ultrasound in the Management of Pancreatic Cancer
Balaji Musunuri, Shiran Shetty
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Julio Iglesias-García, Yessica Domínguez-Novoa, Héctor Lazare-Iglesias, Antonio González-Cantalapiedra, Ihab Abdulkader-Nallib, Óscar Varela-López, José Lariño-Noia, Enrique Domínguez-Muñoz
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S. Karim, S. Kadir, A. Faryal
Endoscopy.2024; 56(S 02): S153. CrossRef - Optimising EUS-FNB guided tissue acquisition: The significance of TRAP score in solid pancreatic and gastrointestinal lesions for positive diagnostic output
S. Karim, S. Kadir, A. Faryal
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Irem Guvendir, Itir Ebru Zemheri, Kamil Ozdil
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Kwang Hyuck Lee
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Case Report
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Conversion of Percutaneous Cholecystostomy to Endoscopic Gallbladder Stenting by Using the Rendezvous Technique
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Kwangwoo Nam, Jun-Ho Choi
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Clin Endosc 2017;50(3):301-304. Published online November 7, 2016
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DOI: https://doi.org/10.5946/ce.2016.120
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Abstract
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- We report the successful conversion of percutaneous cholecystostomy (PC) to endoscopic transpapillary gallbladder stenting (ETGS) with insertion of an antegrade guidewire into the duodenum. An 84-year-old man presented with severe acute cholecystitis and septic shock. He had significant comorbidities, and emergent PC was successfully performed. Subsequent ETGS was attempted but unsuccessful owing to difficulties with cystic duct cannulation. However, via the PC tract, the guidewire was passed antegradely into the duodenum, and ETGS with a double-pigtail plastic stent was successfully performed with the rendezvous technique. The PC tube was removed, and no recurrence was reported during the 17-month follow-up period. Conversion of PC to ETGS is a viable option in patients with acute cholecystitis who are not candidates for surgery. Antegrade guidewire insertion via the PC tract may increase the success rate of conversion and decrease the risk of procedure-related complications.
Original Article
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Endoscopic Ultrasonography-Guided Ethanol Ablation for Small Pancreatic Neuroendocrine Tumors: Results of a Pilot Study
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Do Hyun Park, Jun-Ho Choi, Dongwook Oh, Sang Soo Lee, Dong-Wan Seo, Sung Koo Lee, Myung-Hwan Kim
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Clin Endosc 2015;48(2):158-164. Published online March 27, 2015
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DOI: https://doi.org/10.5946/ce.2015.48.2.158
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Abstract
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- Background/Aims
Endoscopic ultrasonography (EUS)-guided ethanol ablation is gaining popularity for the treatment of focal pancreatic lesions. The aim of this study was to evaluate the safety, feasibility, and treatment response after EUS-guided ethanol injection for small pancreatic neuroendocrine tumors (p-NETs).
MethodsThis was a retrospective analysis of a prospectively collected database including 11 consecutive patients with p-NETs who underwent EUS-guided ethanol injection.
ResultsEUS-guided ethanol injection was successfully performed in 11 patients with 14 tumors. The final diagnosis was based on histology and clinical signs as follows: 10 non-functioning neuroendocrine tumors and four insulinomas. During follow-up (median, 370 days; range, 152 to 730 days), 10 patients underwent clinical follow-up after treatment, and one patient was excluded because of loss to follow-up. A single treatment session with an injection of 0.5 to 3.8 mL of ethanol resulted in complete responses (CRs) at the 3-month radiologic imaging for seven of 13 tumors (response rate, 53.8%). Multiple treatment sessions performed in three tumors with residual viable enhancing tissue increased the number of tumors with CRs to eight of 13 (response rate, 61.5%). Mild pancreatitis occurred in three of 11 patients.
ConclusionsEUS-guided ethanol injection appears to be a safe, feasible, and potentially effective method for treating small p-NETs in patients who are poor surgical candidates.
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Citations
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International Journal of Gastrointestinal Intervention.2020; 9(4): 135. CrossRef - Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasound for the Guidance and Monitoring of Endoscopic Radiofrequency Ablation
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