Clinical efficacy and safety of mucosal incision-assisted biopsy for the diagnosis of upper gastrointestinal subepithelial tumors: A systematic review and meta-analysis

Amaninder Dhaliwal; Sindhura Kolli; Banreet Singh Dhindsa; Kalpit Devani; Daryl Ramai; Harlan Sayles; Rajani Rangray; Ishfaq Bhat; Shailender Singh; Douglas G Adler

doi:10.20524/aog.2020.0460

Clinical efficacy and safety of mucosal incision-assisted biopsy for the diagnosis of upper gastrointestinal subepithelial tumors: A systematic review and meta-analysis

Ann Gastroenterol. 2020 Mar-Apr;33(2):155-161. doi: 10.20524/aog.2020.0460. Epub 2020 Feb 14.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, University of Nebraska Medical Center (Amaninder Dhaliwal, Ishfaq Bhat, Shailender Singh).
² Department of Medicine, NYU Langone Medical Center, NY (Sindhura Kolli).
³ Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas (Banreet Singh Dhindsa).
⁴ Department of Gastroenterology, East Tennessee University, Johnson City, TN (Kalpit Devani).
⁵ Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY (Daryl Ramai).
⁶ Department of Biostatistics, University of Nebraska Medical Center, Omaha (Harlan Sayles).
⁷ Division of Gastroenterology and Hepatology, CHI-Creighton University Medical Center, Omaha, NE (Rajani Rangray).
⁸ Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah (Douglas G. Adler), USA.

Abstract

Background: Endoscopic ultrasound-guided fine-needle aspiration and biopsy (EUS-FNA/FNB) has been traditionally used for making a tissue diagnosis. Several newer techniques are emerging as a viable alternative to EUS-FNA/FNB, including mucosal incision-assisted biopsy (MIAB), with a view to increasing the diagnostic yield for upper gastrointestinal (GI) subepithelial tumors (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. The primary outcome of our meta-analysis was the overall diagnostic yield of the MIAB. The secondary outcome was to study complications in terms of perforation and clinically significant bleeding. The meta-analysis was performed using a DerSimonian and Laird random-effect model.

Results: Seven studies were included in the final meta-analysis, reporting a total of 159 patients (male 86, female 73) with a mean age of 58 years. The overall pooled diagnostic yield of MIAB was 89% (95% confidence interval [CI] 82.65-93.51, I ²=0.00). Histologically, GI stromal tumor was the reported diagnosis in 38.62% (95%CI 22.29-56.24, I ²=77.51%) of tumors, followed by leiomyoma 25% (95%CI 18.02-32.62, I ²=4.42%). The overall rate of clinically significant bleeding following the procedure was 5.03% (95%CI 0.36-12.86, I ²=57.43%) and no perforations were reported.

Conclusions: MIAB is a safe and effective technique for the 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.

Keywords: Mucosal; biopsy; gastrointestinal; incision; subepithelial.