Compliance with surveillance recommendations for foregut subepithelial tumors is poor: results of a prospective multicenter study

Background: American Gastroenterological Association guidelines recommend performing EUS to characterize subepithelial lesions (SELs) discovered on upper endoscopy (EGD), followed by surveillance if no high-risk features are identified. However, limited data are available on the impact of and compliance with surveillance recommendations. Objective: To determine the natural history of SELs < 30 mm in size evaluated by EUS and to determine the degree of patient compliance with surveillance recommendations. Design: Prospective registry. Setting: Two tertiary centers. Patients: We studied 187 consecutive adult patients referred for EUS evaluation of foregut SELs. Main Outcome Measurements: Proportion of patients in whom SELs change in size or echo-features and compliance with follow-up recommendations. Results: Surveillance was recommended in 65 patients with hypoechoic SELs (44.6% women, age 59.5 +/- 13.2 years); of these, 29 (44.6%) underwent surveillance EUS as recommended and were followed for a median of 30 months (range, 12-105). During follow-up, 16 SELs (25%) increased in size, with a mean increase of 3.4 +/- 3.9 mm (range, 1-15). No changes in echo-texture of the SELs were observed. One patient was referred to surgery during follow-up (because of SEL growth > 30 mm). Limitations: Short follow-up duration; compliance was a secondary aim. Conclusions: During a median follow-up of 30 months, growth in size was observed in 25% of small foregut SELs. However, change in size was minimal, and only 1 patient was referred for surgery based on surveillance EUS findings. Compliance with surveillance recommendations is poor, with fewer than 50% of patients undergoing surveillance EUS as recommended.