Abstract
Upper gastrointestinal (GI) subepithelial tumors (SETs) are frequently encountered during esophagogastroduodenoscopy (EGD). Endoscopic Ultrasound guided fine-needle aspiration and biopsy (EUS-FNA/FNB) has been traditionally used for making the tissue diagnosis. However, tissue sample obtained using EUS-FNA/FNB sometimes may not be adequate for histological and immunochemical analysis, thus limiting its utility. Several newer techniques are emerging as a viable alternative to EUS-FNA/FNB including mucosal incision assisted biopsy (MIAB) for increasing the diagnostic yield for upper GI SETs. We conducted a systematic review and meta-analysis to describe the overall diagnostic yield of MIAB for upper GI SETs. Methods: Multiple electronic databases (MEDLINE, EMBASE and Google Scholar) and conference abstracts were comprehensively searched to identify studies reporting MIAB for diagnosis of upper gastrointestinal SETs. References from identified studies were then manually searched for any additional studies. Primary outcome of our meta-analysis was the overall diagnostic yield of the MIAB. Secondary outcome was to study complications in terms of perforation and major bleeding. Major bleeding was defined as bleeding requiring blood transfusion or endoscopic intervention. The meta-analysis was performed using Der Simonian and Laird random effect model. Results: 7 studies were included in the final meta-analysis reporting a total of 159 patients (males 86 and females 73) with mean age of 58 years. The mean tumor size was 21.0 mm (95% CI = 18.1 - 24.0, I2 = 89.73) and mainly located in the stomach (94.76%, 95% CI = 78.46-100, I2=84.49%). The overall pooled diagnostic yield of MIAB was 88.55 % (95% CI = 82.65 - 93.51, I2 =0.00) (Figure 1). Histologically, gastrointestinal stromal tumor (GIST) was reported diagnosis in 38.62% (95% CI = 22.29 - 56.24, I2 = 77.51%) of tumors followed by leiomyoma 25% (95% CI=18.02-32.62, I2= 4.42%). Overall rate of major bleeding following the procedure was 5.03 % (95% CI =0.36 - 12.86, I2 = 57.43%) and no perforation was reported in any of the seven studies Conclusion: MIAB is a safe and effective technique (overall diagnostic yield of 88.55%) in diagnosis of upper GI SETs and can be considered as a viable alternative to EUS-FNA/FNB. MIAB can be performed during routine endoscopy and no advanced equipment is required. However, further randomized control trials are needed to validate these findings