ASGE Endo Hangout: Lumps and Bumps | October 2025-Recorded Webinar

Video Transcription

Video Summary

This ASGE EndoHangout webinar, tailored for GI fellows, focused on subepithelial lesions (SELs)—also called "lumps and bumps"—in the gastrointestinal (GI) tract. Moderated by GI fellow Himesh Zaber, experts Dr. Vanessa Shamy and Dr. Mark Radlinsky shared diagnostic and management insights through clinical cases.<br /><br />SELs are well-defined masses with overlying mucosa that may be benign or malignant and often found incidentally during endoscopy or imaging. Notably, up to one-third represent extrinsic compression from adjacent organs like liver, spleen, or pancreatic cysts, highlighting the importance of endoscopic assessment and endoscopic ultrasound (EUS) for differentiation.<br /><br />Drs. Shamy and Radlinsky emphasized using tactile assessment during endoscopy (e.g., pillow sign for lipomas), lesion hue, and careful endoscopic visualization to narrow differentials before EUS. EUS helps identify lesion layer of origin (muscularis mucosa, submucosa, muscularis propria) and echogenicity (hyperechoic, hypoechoic, or anechoic) guiding diagnosis (e.g., lipomas, GISTs, neuroendocrine tumors). Doppler enhances vascular lesion identification, preventing dangerous biopsies (e.g., varices).<br /><br />Tissue acquisition strategies discussed included fine needle aspiration (FNA) with rapid on-site evaluation (ROSE) and fine needle biopsy (FNB), balancing diagnostic yield and procedural efficiency. Management is multidisciplinary; symptomatic or high-risk lesions often require resection, while small low-risk lesions may be surveilled.<br /><br />Immunohistochemistry markers like CKIT and DOG1 differentiate GISTs from leiomyomas. Neuroendocrine tumors are subtyped by gastrin levels and histology, guiding therapy and surveillance. Rare diagnoses like MALT lymphoma underscore the need for expert collaboration.<br /><br />The session concluded with a practical decision algorithm for SEL evaluation per ACG guidelines and career advice highlighting mentorship, curiosity, and evolving endoscopic technologies such as third-space endoscopy and endorobotics anticipated to expand therapeutic options. This interactive webinar enhanced fellows’ understanding of the complex evaluation and management of subepithelial GI lesions.

Keywords

Subepithelial lesions

Gastrointestinal tract

Endoscopy

Endoscopic ultrasound (EUS)

Fine needle aspiration (FNA)

Fine needle biopsy (FNB)

Gastrointestinal stromal tumors (GISTs)

Neuroendocrine tumors

Immunohistochemistry markers

Multidisciplinary management

Endoscopic technologies