Benign Disease

There has been no clear role established for the use of EUS in evaluating gastric polyps. EUS cannot differentiate malignant from inflammatory epithelial polyps unless there is infiltration into layers beyond the submucosa [641]. In polyps, EUS can define large vessels that could pose a risk for endoscopic polypectomy [65]. EUS evaluation of suspicious gastric ulcers with a biopsy negative for malignancy has not proven to be useful in making any further diagnosis. Changes of the EUS wall layer resembling malignancy regularly occur in the course of ulcer disease, making EUS differentiation between benign and malignant wall changes very difficult, if not impossible [66]. A few reports [67] indicate that the EUS pattern of benign gastric ulcers may help to predict healing rates and therefore identify ulcers that would tend to be refractory to standard treatment.

EUS appears to have a major role only in patients with giant gastric folds. EUS can define areas of abnormality that are most likely to yield a positive deep biopsy. Gastric wall thickening involving only the first 2 mucosal layers is characteristic of hyperplastic wall thickening in Ménétrier's disease. Mucosal wall thickening can also occur in early lymphomas, but lymphomas generally cause a thickening of the submucosal layer.

One important use of EUS in evaluating large gastric folds is to exclude gastric varices. The portal venous system can be well visualized with EUS [68]. Endoscopy has been shown to be superior to EUS for grading esophageal varices; however, EUS has been shown to be far superior to endoscopy or other imaging techniques in detecting gastric varices. EUS has been shown to diagnose gastric varices in up to 80% of patients when gastric varices were not diagnosed by standard endoscopy. However, other than the use of EUS to diagnose a gastric varix when a submucosal lesion is seen, there are no established clinical indications for the use of EUS in portal hypertension.

Continued »