{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T12:39:57Z","timestamp":1776083997595,"version":"3.50.1"},"reference-count":138,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Main Recommendations<\/jats:title><jats:p>1 ESGE recommends endoscopic ultrasonography (EUS) as the best tool to characterize subepithelial lesion (SEL) features (size, location, originating layer, echogenicity, shape), but EUS alone is not able to distinguish among all types of SEL.<\/jats:p><jats:p>Strong recommendation, moderate quality evidence.<\/jats:p><jats:p>2 ESGE suggests providing tissue diagnosis for all SELs with features suggestive of gastrointestinal stromal tumor (GIST) if they are of size &gt;\u200a20\u200amm, or have high risk stigmata, or require surgical resection or oncological treatment.<\/jats:p><jats:p>Weak recommendation, very low quality evidence.<\/jats:p><jats:p>3 ESGE recommends EUS-guided fine-needle biopsy (EUS-FNB) or mucosal incision-assisted biopsy (MIAB) equally for tissue diagnosis of SELs \u2265\u200a20\u200amm in size.<\/jats:p><jats:p>Strong recommendation, moderate quality evidence.<\/jats:p><jats:p>4 ESGE recommends against surveillance of asymptomatic gastrointestinal (GI) tract leiomyomas, lipomas, heterotopic pancreas, granular cell tumors, schwannomas, and glomus tumors, if the diagnosis is clear.<\/jats:p><jats:p>Strong recommendation, moderate quality evidence.<\/jats:p><jats:p>5 ESGE suggests surveillance of asymptomatic esophageal and gastric SELs without definite diagnosis, with esophagogastroduodenoscopy (EGD) at 3\u20136 months, and then at 2\u20133-year intervals for lesions &lt;\u200a10\u200amm in size, and at 1\u20132-year intervals for lesions 10\u201320\u200amm in size. For asymptomatic SELs &gt;\u200a20\u200amm in size that are not resected, ESGE suggests surveillance with EGD plus EUS at 6 months and then at 6\u201312-month intervals.<\/jats:p><jats:p>Weak recommendation, very low quality evidence.<\/jats:p><jats:p>6 ESGE recommends endoscopic resection for type 1 gastric neuroendocrine neoplasms (g-NENs) if they grow larger than 10\u200amm. The choice of resection technique should depend on size, depth of invasion, and location in the stomach.<\/jats:p><jats:p>Strong recommendation, low quality evidence.<\/jats:p><jats:p>7 ESGE suggests considering removal of histologically proven gastric GISTs smaller than 20\u200amm as an alternative to surveillance. The decision to resect should be discussed in a multidisciplinary meeting. The choice of technique should depend on size, location, and local expertise.<\/jats:p><jats:p>Weak recommendation, very low quality evidence.<\/jats:p><jats:p>8 ESGE suggests that, to avoid unnecessary follow-up, endoscopic resection is an option for gastric SELs smaller than 20\u200amm and of unknown histology after failure of attempts to obtain diagnosis.<\/jats:p><jats:p>Weak recommendation, very low quality evidence.<\/jats:p><jats:p>9 ESGE recommends basing the surveillance strategy on the type and completeness of resection. After curative resection of benign SELs no follow-up is advised, except for type 1 gastric NEN for which surveillance at 1\u20132 years is advised.<\/jats:p><jats:p>Strong recommendation, low quality evidence.<\/jats:p><jats:p>10 For lower or upper GI NEN with a positive or indeterminate margin at resection, ESGE recommends repeating endoscopy at 3\u20136 months and another attempt at endoscopic resection in the case of residual disease.<\/jats:p><jats:p>Strong recommendation, low quality evidence.<\/jats:p>","DOI":"10.1055\/a-1751-5742","type":"journal-article","created":{"date-parts":[[2022,2,19]],"date-time":"2022-02-19T00:25:05Z","timestamp":1645230305000},"page":"412-429","source":"Crossref","is-referenced-by-count":327,"title":["Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) 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Gastroent\u00e9rologie et Endoscopie Digestive, H\u00f4pital Priv\u00e9 Jean Mermoz, Lyon, France"}]},{"given":"Andrada","family":"Seicean","sequence":"additional","affiliation":[{"name":"Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania"}]},{"given":"Pedro","family":"Pimentel-Nunes","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Portuguese Oncology Institute of Porto; Department of Surgery and Physiology, Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Portugal"}]},{"given":"Gloria","family":"Fern\u00e1ndez-Esparrach","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Institut de Malalties Digestives i Metaboliques, Hospital Cl\u00ednic, Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4934-9759","authenticated-orcid":false,"given":"Marcin","family":"Polkowski","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Clinical Oncology, Center for Postgraduate Medical Education, and Department of Oncological Gastroenterology, Maria Sk\u0142odowska-Curie National Research Institute of Oncology, Warsaw, Poland"}]},{"given":"Michael","family":"Vieth","sequence":"additional","affiliation":[{"name":"Institut of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany"}]},{"given":"Ivan","family":"Borbath","sequence":"additional","affiliation":[{"name":"Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Universit\u00e9 Catholique de Louvain, Brussels, Belgium"}]},{"given":"Tom G.","family":"Moreels","sequence":"additional","affiliation":[{"name":"Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Universit\u00e9 Catholique de Louvain, Brussels, Belgium"}]},{"given":"Els","family":"Nieveen van Dijkum","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, The Netherlands"}]},{"given":"Jean-Yves","family":"Blay","sequence":"additional","affiliation":[{"name":"Centre L\u00e9on B\u00e9rard, Universit\u00e9 Claude Bernard Lyon 1, Lyon, France"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4424-0079","authenticated-orcid":false,"given":"Jeanin E.","family":"van Hooft","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands"}]}],"member":"194","published-online":{"date-parts":[[2022,2,18]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/1472-6963-4-38","article-title":"Systems for grading the quality of evidence and the strength of recommendations I: Critical appraisal 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