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July 13, 2021 — Digestive and Liver Disease



Standard B-mode EUS assessment and EUS-guided tissue acquisition present sub-optimal diagnostic yield in the differential diagnosis of gastric submucosal tumors (SMTs).


To evaluate the performances of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) to differentiate gastric SMTs and predict malignancy risk of gastrointestinal stromal tumors (GIST).


A retrospective analysis was performed retrieving consecutive patients with gastric SMTs who underwent EUS between 2009 and 2014. Patients with available EUS video recordings and histological diagnosis were included. De-identified videos were presented to experts who made a diagnosis on B-mode EUS and CH-EUS.


Fifty-four patients (29 female, 64-year-old) were included. Final diagnoses were 40 GISTs (8 high-grade), 9 leiomyomas, 5 rare SMTs. The sensitivity, specificity, and accuracy of B-mode and CH-EUS for the differential diagnosis of GIST were 95.0% vs. 85.0%, 57.1% for both techniques, and 85.2% vs. 77.8%, respectively. The sensitivity, specificity, and accuracy of B-mode and CH-EUS for the estimation of the malignancy GISTs risk were 62.5% vs. 100%, 83.3% vs. 82.1%, and 78.9% vs. 86.1%, respectively.


CH-EUS showed better diagnostic performance than B-mode EUS in differentiating leiomyomas and risk stratification of GIST. When considering high-grade GISTs, the addition of CH-EUS allowed an improvement in diagnostic accuracy.

Authors: Christine Lefort 1; Vikas Gupta 2; Andrea Lisotti 1,3; Laurent Palazzo 4; Pietro Fusaroli 3; Bertrand Pujol 1; Rodica Gincul 1; Fabien Fumex 1; Maxime Palazzo 5; Bertrand Napoléon 1

1 Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France; 2 Gastroenterology Unit, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; 3 Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy; 4 Endoscopy Unit, Clinique du Trocadéro, Paris, France; 5 Endoscopy Unit, Hôpital Européen, Marseille, France

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