Subepithelial lesions of the upper gastrointestinal tract: proposal for a management algorithm

A review of current available literature on the concepts, diagnoses and approaches of subepithelial lesions (SELs) of the upper gastrointestinal tract was carried out in order to propose an algorithm for the diagnosis and management of SELs for Costa Rican hospitals. A detailed search for bibliographic information was carried out regarding the epidemiology, diagnosis, and management of subepithelial lesions in the upper gastrointestinal tract. A flow chart to manage subepithelial lesions of the upper gastrointestinal tract was proposed in order to make sequential and staggered management practical and simple for daily application. The flow chart was developed as an orientation for decision making, however, each case must always be individualized. Most SELs have been documented incidentally by endoscopy performed routinely for other symptoms. Leiomyomas have been found to be the most frequent SELs at the esophageal level and are generally benign. Digestive endoscopy has been the first step in the evaluation of SELs and has made it possible to describe the appearance, location and size of the lesion. Most of the malignant lesions have been hypoechoic and located in the third and fourth echolayers, making it necessary to perform a biopsy. The standard treatment for malignant SELs has been surgery, however new endoscopic management techniques have sought to reduce morbidity and mortality when resecting SELs