Factors Associated with Clinically Significant Extrinsic Compression on Gastroduodenal Endoscopy

Factors Associated with Clinically Significant Extrinsic Compression on Gastroduodenal Endoscopy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Associated with Clinically Significant Extrinsic Compression on Gastroduodenal Endoscopy Jin Young Yoon, Jin Kyung Bae, Su Bee Park, Jae Jun Park, Jung Won Jeon, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5472506/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Jan, 2025 Read the published version in Digestive Diseases and Sciences → Version 1 posted 9 You are reading this latest preprint version Abstract Background Although clinicians frequently encounter incidentally detected gastroduodenal extrinsic compressive lesion (GDECL) on upper gastrointestinal endoscopy (UGE), optimal management approach for GDECL has not been fully established. This study aimed to stratify and identify important factors associated with clinically significant GDECLs that require regular follow-up or further treatment. Methods Between June 2011 and December 2015, a total of 73 patients with suspected GDECL on UGE at Kyung Hee University Hospital at Gangdong were identified and studied retrospectively. After the final diagnosis, patients were divided into the following two groups: clinically significant GDECL, which requires regular follow-up or further treatment, and clinically non-significant GDECL. Results Among 73 GDECLs, 23 (31.5%) lesions were classified as clinically significant GDECLs and 50 (68.5%) as clinically non-significant GDECLs. Clinical and endoscopic parameters that were associated with clinically significant GDECLs included older age (≥ 60 years) (odds ratio [OR] = 7.73, p < 0.05), large size (≥ 4 cm) of extrinsic compression (OR = 7.77, p < 0.05), previous history of intra-abdominal malignancy (OR = 17.55, p < 0.05), and symptoms of abdominal distension (OR = 51.34, p < 0.05). Conclusions Several clinical and endoscopic parameters showed significant association with the development of clinically significant GDECLs on endoscopy. These predictive factors might be useful in determining whether to perform further diagnostic work-up in patients with GDECLs. Extrinsic compression Endoscopy Subepithelial lesion Figures Figure 1 Figure 2 Figure 3 Introduction A luminal protruding lesion covered by normal-appearing mucosa, which is commonly encountered on upper gastrointestinal endoscopy (UGE), can arise from a wide range of non-neoplastic and neoplastic conditions, spanning from a discrete mass originating in any layer of the gastrointestinal wall to extrinsic compression by neighboring structures. Among these, extrinsic compressive lesions caused by structures surrounding the stomach and duodenum can be referred to as gastroduodenal extrinsic compressive lesions (GDECLs). GDECLs are often incidentally identified in asymptomatic patients, and their differential diagnosis ranges from normal variations due to adjacent abdominal structures to pathological lesions caused by neighboring organs or isolated intra-abdominal conditions that require further evaluation [ 1 ]. Although a significant number of GDECLs are caused by normal variations due to adjacent abdominal structures, clinically significant lesions that require further evaluation or treatment may also be present. Considering this, clinicians often deliberate over the need for additional diagnostic tests when encountering such lesions. However, clear guidelines for assessing the risk associated with these lesions remain lacking [ 2 – 5 ]. Currently, various diagnostic modalities, including transabdominal ultrasonography, endoscopic ultrasonography (EUS), computed tomography (CT), and magnetic resonance imaging (MRI), can be considered as additional workups, but these evaluations incur healthcare costs [ 2 ]. Given that a considerable portion of GDECLs is likely to be clinically insignificant lesions, such as normal surrounding organs, identifying clinical indicators that assist in the risk stratification of these lesions could guide decisions regarding additional evaluation. Accordingly, the aim of this study is to identify clinical and endoscopic parameters associated with clinically significant GDECLs. Materials and Methods Study population This was a retrospective, single-center, cross-sectional study. Patients who underwent upper gastrointestinal endoscopy (UGE) at Kyung Hee University Hospital at Gangdong between June 2011 and December 2015 were considered for inclusion. Those with incidentally detected gastroduodenal extrinsic compressive lesions (GDECLs) on UGE were included in the study. The exclusion criteria were as follows: (1) patients who had not undergone at least one additional diagnostic modality, including endoscopic ultrasonography (EUS), computed tomography (CT) scan, transabdominal ultrasonography, or magnetic resonance imaging (MRI); (2) patients with insufficient information; and (3) patients who were ultimately diagnosed with a subepithelial tumor. The study was conducted in accordance with the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Institutional Review Board of Severance Hospital (IRB number KHNMC 2024-09-016). The requirement for written informed consent from enrolled participants was waived due to the retrospective nature of the study. Clinical evaluations In this single-center retrospective study, clinical variables and demographic characteristics were collected using self-administered questionnaires. The collected variables included the patient’s age, sex, medical history, and the reason for undergoing the initial UGE (e.g., screening or symptom evaluation). Additionally, any symptoms potentially associated with GDECL were also documented. Upper gastrointestinal endoscopy All patients underwent at least one upper gastrointestinal endoscopy (UGE) to confirm the presence and location of the GDECL. The UGEs were performed either by a board-certified faculty member affiliated with the gastroenterology department at a university hospital or by a gastroenterology fellow under supervision. Endoscopy reports and images of all patients were reviewed by experienced gastroenterologists to verify the relevant findings. During the procedure, the size, location, and presumptive diagnosis of the GDECL were documented. The location of GDECLs within the stomach was further categorized into the upper, middle, and lower thirds. The size of the GDECL was estimated by measuring the maximum diameter of the compression, using biopsy forceps as a reference for dimension. Additional examination after UGE All patients underwent at least one additional examination, such as a CT scan, MRI, or EUS, to determine the cause of GDECLs and establish a final diagnosis. The selection of imaging modalities varied by patient and was decided by the attending gastroenterologists. Based on the final diagnosis, patients were categorized into two groups: (1) clinically significant GDECL, referring to lesions that require further treatment or regular follow-up, and (2) clinically non-significant GDECL, referring to normal or benign findings that do not necessitate further diagnostic steps. Clinically significant GDECLs were further subdivided into malignant or benign lesions based on the necessity for appropriate treatment. Statistical analysis Continuous variables were presented as mean (±SD). Clinical characteristics were compared between the significant GDECL and non-significant GDECL groups. Categorical variables were analyzed using chi-square tests or Fisher’s exact tests for univariate analysis. Variables found to be significant in the univariate analysis were subsequently included in a multivariate logistic regression to identify independent predictors of clinically significant GDECL. All statistical tests were two-sided, and a p value <0.05 was considered statistically significant. All statistical analyses were performed using SPSS for Windows, version 18.0 (SPSS, Inc., Chicago, IL, USA). Results Baseline characteristics After excluding nine patients who were finally diagnosed with subepithelial tumors, 24 patients who lacked further evaluation, and one patient who had undergone subtotal gastrectomy, a total of 73 patients were included in this study ( Figure 1 ). The baseline characteristics of the 73 enrolled patients are summarized in Table 1. The mean age at presentation was 56.0 (±15.0) years. Among these patients, 29 (39.7%) were male and 44 (60.3%) were female. Regarding comorbidities, the prevalence of hypertension and diabetes mellitus was 19.2% (n=14) and 6.8% (n=5), respectively. Previous extra-abdominal malignancies were present in 5.5% (n=4) of patients, while 4.1% (n=3) had cardiopulmonary disease. The primary reasons for undergoing initial UGE were screening in 18 patients (24.7%) and non-specific gastrointestinal symptoms in 55 patients (75.3%). Epigastric pain was the most common symptom, prompting 33 patients (45.2%) to undergo UGE. Other symptoms potentially related to the mass effect of GDECL included vomiting in eight patients (11.0%), abdominal distension in seven patients (9.6%), and weight loss in seven patients (9.6%). Endoscopic examinations were performed by gastroenterology faculty members in 48 patients (65.8%) and by medical trainees in 25 patients (34.2%). The mean diameter of GDECLs was 3.4 ± 1.8 cm. GDECLs were in the stomach in 62 patients (84.9%), and in the duodenum in 11 patients (15.1%). Among the GDECLs located in the stomach, 26 cases (35.6%) were in the upper third, 12 cases (16.4%) in the middle third, and 24 cases (32.9%) in the lower third of the stomach. For additional examination, EUS was performed in four patients (5.5%), abdominal CT scan in 54 patients (74.0%), transabdominal ultrasonography in 19 patients (26.0%), and MRI in one patient (1.4%). Classification of gastroduodenal extrinsic compressive lesions (GDECLs) identified by additional examination Among the 73 patients, 54 (74.0%) underwent an abdominal CT scan, 19 (26.0%) underwent transabdominal ultrasonography, four (5.5%) underwent EUS, and one (1.4%) underwent an MRI. Following these additional examinations, 23 GDECLs (31.5%) were classified as clinically significant, while 50 GDECLs (68.5%) were classified as clinically non-significant ( Figure 2 ). Clinically non-significant GDECLs were most commonly confirmed to be normal adjacent organs in 47 cases (64.3%) ( Figure 3A ) and simple hepatic cysts in three cases (4.1%). Clinically significant GDECLs were further divided into two subgroups: 20 (27.3%) malignant lesions and three (4.1%) benign lesions. The malignant lesions included the following diagnoses: 10 hepatobiliary cancers ( Figure 3B ), five peritoneal carcinomatoses, four pancreatic cancers, and one renal cell carcinoma. The benign lesions consisted of two pancreatic pseudocysts and one omental lymphangioma. Factors associated with clinically significant GDECLs Table 2 presents the differences between patients with clinically significant GDECLs and those with clinically non-significant GDECLs. In the univariate analysis, the likelihood of clinically significant GDECLs was significantly higher in patients older than 60 years and those with a history of intra-abdominal malignancy ( p <0.05). Additionally, symptoms of abdominal distension and weight loss were significantly associated with an increased risk of clinically significant GDECLs ( p <0.05). A large size (≥4cm) of extrinsic compression was also significantly associated with the presence of clinically significant GDECLs ( p <0.05). The statistical significance of these factors remained consistent in the multivariate analysis ( Table 3 ). After multivariate adjustment, an age greater than 60 years was associated with a 7.73-fold higher risk of clinically significant GDECLs ( p <0.05). Similarly, a large size (≥4 cm) of GDECLs, symptoms of abdominal distension, and a history of intra-abdominal malignancy were significantly associated with higher risks of clinically significant GDECLs compared to their absence (OR = 7.77, 51.34, and 17.55, respectively; all p <0.05). Other clinical factors, including sex, comorbid medical conditions, the location of GDECL, and the level of experience of the endoscopist, did not show a significant association with the increased risk of clinically significant GDECLs. Discussion In this single-center, cross-sectional retrospective study, we identified several clinical factors that are significantly associated with clinically significant GDECL. Advanced age (> 60 years), symptoms of abdominal distension or weight loss, a history of intra-abdominal malignancy, and large lesion size (≥ 4cm) were all linked to an increased risk of clinically significant GDECLs. Our findings may assist clinicians in deciding whether to perform additional examinations for incidentally detected GDECLs. These predictive factors could be valuable in risk stratification and guiding appropriate management strategies, potentially reducing unnecessary examinations. Only a limited number of studies have investigated the clinical factors associated with GDECLs. Although two previous studies addressed extrinsic compression, they were unable to analyze significant factors due to small sample sizes [ 3 , 4 ]. To our knowledge, this is the first study to evaluate the prevalence of GDECLs and identify potential risk factors related to their clinical significance. Our study found that GDECLs with a maximum diameter greater than 4 cm are significantly associated with the need for clinical treatment (OR = 7.77, p < 0.05). This is likely due to the higher malignant potential of larger lesions, as larger compressive masses, such as those seen in hepatobiliary and pancreatic cancers, are often indicative of a more aggressive or advanced disease process. Similar to our study on extrinsic compressive lesions, previous literature on subepithelial tumors (SETs) has also demonstrated that lesion size is a key factor in determining malignant potential of the lesion. Previous studies have investigated the association between malignancy potential of GDECLs and age/gender, yet the results have been controversial [ 6 – 8 ]. One study reported that a higher prevalence of comorbidities in elderly patients is associated with an increased risk of extrinsic compression as determined by EUS, but it did not identify any age- or sex-related predictive factors [ 2 ]. Our study showed that clinically significant GDECL is not significantly associated with sex, but it is significantly associated with older age (> 60 years) The strong association between advanced age and clinically significant GDECLs can be largely explained by the increased prevalence of malignancies in older individuals. As people age, the risk of developing various cancers rises. Among various symptoms, abdominal distension was strongly associated with an increased risk of clinically significant GDECL. This association may be due to the direct mass effect of the lesion, leading to physical compression and the sensation of distension. Additionally, abdominal distension may indicate larger, more advanced lesions with higher clinical significance. In malignancies such as peritoneal carcinomatosis, the development of ascites can further contribute to this symptom, underscoring its importance as a potential indicator of serious underlying pathology. Regarding additional diagnostic modalities for GDECLs, the optimal diagnostic tool has yet to be definitively established. In our study, the following examinations were performed: abdominal CT scan (74.0%), transabdominal ultrasonography (26.0%), endoscopic ultrasonography (5.5%), and magnetic resonance imaging (1.4%), with abdominal CT being the most frequently used. Previous studies reported that US and CT had an accuracy of 19% compared to 100% with EUS for detecting extrinsic compression [ 3 ]. While EUS offers superior resolution for small focal lesions, CT has a significant advantage in assessing the extent of the process and involvement of other organs [ 9 ]. Although EUS has challenged the primary role of CT or MRI in the differential diagnosis of SET, combining these modalities with EUS can help clarify the nature and extent of the lesion [ 10 ]. Further research is needed to determine the most appropriate additional examinations for incidentally discovered GDECLs. Our study had several limitations. First, since this was a single-center study, the generalizability of our findings may be limited. Second, there is a possibility that experienced endoscopists might have identified certain extrinsic compressions as definite normal structures, such as the spleen at the great curvature of the upper body and did not record them in the endoscopic report. Third, we were unable to capture cases where the diagnosis changed from subepithelial tumor to extrinsic compression during the course of evaluation. Finally, the retrospective nature of the study means that we were reliant on the accuracy and completeness of existing medical records, which may have introduced some bias. Despite these limitations, our study provides valuable insights that can help clinicians make informed decisions about further examinations in patients with incidentally identified GDECLs. In conclusion, although the management strategy for extrinsic compressive lesions detected on UGE remains controversial, additional examinations should be actively considered in patients over the age of 60 years, as well as those with large compressive lesions (≥ 4 cm in maximum diameter), a history of intra-abdominal malignancy, or symptoms of abdominal distension. Proper risk stratification will help better define the optimal management for patients with indeterminate GDECLs. Declarations Author Contribution All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jin Young Yoon, Jin Kyung Bae, Su Bee Park, Jae Jun Park, Jung Won Jeon, and Jae Myung Cha. The first draft of the manuscript was written by Jin Young Yoon and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Disclosures: The authors have no conflicts of interest to declare. References Hwang, J.H., et al., American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses . Gastroenterology, 2006. 130(7): p. 2217–28. Oztas, E., et al., Endosonographic evaluation of patients with suspected extraluminal compression or subepithelial lesions during upper gastrointestinal endoscopy . Eur J Gastroenterol Hepatol, 2011. 23(7): p. 586–92. Motoo, Y., et al., Endoscopic ultrasonography in the diagnosis of extraluminal compressions mimicking gastric submucosal tumors . Endoscopy, 1994. 26(2): p. 239–42. Chen, T.K., et al., Endoscopic ultrasonography to study the causes of extragastric compression mimicking gastric submucosal tumor . J Formos Med Assoc, 2001. 100(11): p. 758–61. Shim, J.J., J.Y. Jang, and R. Chang, An unusual EUS finding of a gastric extraluminal compression . Gastrointest Endosc, 2011. 74(2): p. 406–7. Rosch, T., et al., Endosonographic diagnosis of submucosal upper gastrointestinal tract tumors . Scand J Gastroenterol, 1992. 27(1): p. 1–8. Ponsaing, L.G., et al., Diagnostic procedures for submucosal tumors in the gastrointestinal tract . World J Gastroenterol, 2007. 13(24): p. 3301–10. Franco, M.C., R.T. Schulz, and F. Maluf-Filho, Opinion: How to manage subepithelial lesions of the upper gastrointestinal tract? World J Gastrointest Endosc, 2015. 7(18): p. 1262–7. Dyrla, P., et al., The impact of age and sex on the occurrence of pathology in the wall of the upper gastrointestinal tract . Prz Gastroenterol, 2017. 12(3): p. 192–198. Papanikolaou, I.S., et al., Endoscopic ultrasonography for gastric submucosal lesions . World J Gastrointest Endosc, 2011. 3(5): p. 86–94. Tables Table 1. Baseline characteristics of the study population Variables Mean (±SD) or number (%) Age (years) 56.0 ± 15.4 Male 29 (39.7%) Indication of endoscopic exam Screening Symptoms evaluation 18 (24.7%) 55 (75.3%) Clinical symptoms Epigastric discomfort Abdominal distension Weight loss Vomiting 33 (45.2%) 7 (9.6%) 7 (9.6%) 8 (11.0%) Comorbidity Diabetes mellitus Hypertension Cardiopulmonary disease Previous intra-abdominal malignancy Previous extra-abdominal malignancy 5 (6.8%) 14 (19.2%) 3 (4.1%) 14 (19.2%) 4 (5.5%) Performing endoscopist Faculty Trainee 48 (65.8%) 25 (34.2%) Maximum diameter (cm) of compression 3.4 ± 1.8 Location of compression Stomach Upper 1/3 Middle 1/3 Lower 1/3 Duodenum 62 (84.9%) 26 (35.6%) 12 (16.4%) 24 (32.9%) 11 (15.1%) Additional examination Endoscopic ultrasonography Abdominal CT scan Transabdominal ultrasonography Magnetic resonance imaging 4 (5.5%) 54 (74.0%) 19 (26.0%) 1 (1.4%) Table 2. Comparison of risk factors between clinically significant and non-significant gastroduodenal extrinsic compressive lesions (GDECLs) Variables Clinically significant GDECL (n=23) Clinically non-significant GDECL (n=50) p value Age >60 years 16 (69.6%) 16 (32.0%) 0.003 Male gender 8 (34.8%) 21 (42.0%) 0.558 Clinical symptoms Epigastric discomfort Abdominal distension Weight loss Vomiting 12 (52.5%) 6 (26.1%) 5 (21.7%) 5 (21.7%) 28 (56.0%) 1 (2.0%) 2 (4.0%) 3 (6.0%) 0.760 0.003 0.029 0.099 Comorbidity Diabetes mellitus Hypertension Cardiopulmonary disease Previous intra-abdominal malignancy Previous extra-abdominal malignancy 2 (8.7%) 5 (21.7%) 1 (4.3%) 10 (43.5%) 3 (13.0%) 3 (6.0%) 9 (18.0%) 2 (4.0%) 4 (8.0%) 1 (2.0%) 0.647 0.706 1.000 0.001 0.089 Performing endoscopist Faculty 16 (69.6%) 32 (64.0%) 0.642 Large size (>4 cm) of extrinsic compression 17 (73.9%) 14 (28.0%) <0.001 Location of compression Stomach Upper 1/3 Middle 1/3 Lower 1/3 Duodenum 5 (21.7%) 4 (17.4%) 11 (47.8%) 3 (13.0%) 21 (42.0%) 8 (16.0%) 13 (26.0%) 8 (16.0%) 0.240 Table 3. Multivariate analysis of risk factors for clinically significant gastroduodenal extrinsic compressive lesion (GDECL) Variables p value Odds ratio 95% CI Age >60 years 0.010 7.73 1.61-37.01 Large size (>4 cm) of extrinsic compression 0.011 7.77 1.59-37.82 Previous intra-abdominal malignancy 0.004 17.55 2.55-120.59 Abdominal distension 0.013 51.34 2.29-1149.44 Weight loss 0.389 3.25 0.223-47.36 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Jan, 2025 Read the published version in Digestive Diseases and Sciences → Version 1 posted Editorial decision: Revision requested 21 Nov, 2024 Reviews received at journal 20 Nov, 2024 Reviewers agreed at journal 20 Nov, 2024 Reviews received at journal 19 Nov, 2024 Reviewers agreed at journal 19 Nov, 2024 Reviewers invited by journal 18 Nov, 2024 Editor assigned by journal 18 Nov, 2024 Submission checks completed at journal 18 Nov, 2024 First submitted to journal 17 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5472506","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":380766644,"identity":"85a48436-efd4-48d1-a40e-1d16d2c483a6","order_by":0,"name":"Jin Young Yoon","email":"","orcid":"","institution":"Kyung Hee University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"Young","lastName":"Yoon","suffix":""},{"id":380766648,"identity":"15280e12-59ab-4936-9f55-0979944038cf","order_by":1,"name":"Jin Kyung Bae","email":"","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"Kyung","lastName":"Bae","suffix":""},{"id":380766649,"identity":"512e72de-2de9-4f20-b7a6-c475a7bed2a0","order_by":2,"name":"Su Bee Park","email":"","orcid":"","institution":"Kyung Hee University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Su","middleName":"Bee","lastName":"Park","suffix":""},{"id":380766650,"identity":"7087447a-a688-4df2-996f-1c25d908c5df","order_by":3,"name":"Jae Jun Park","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBACxgYGBgMgbcDPwMBGohbJBmK1wICBwQFitTC3Hz5QXFBzz9j4Ro7Zwx8MdvKEHdaTlmA841ixmdmNHHNjHoZkwwaCWhpyDIx52BJsgFrMpIG2JhC2pf/9B2Oefwk2xjNyzCR/MNQToWVGDoMxb1uCmYFEjpkED8NhYrQ8MzCe2ZdgLHHmWZk0j8Fxwn4x7E9+ZlzwLcGwvz15m+SPimrCIQY0lM0YzBIAOcmAoAYGBqChzI/BLP4DRCgfBaNgFIyCEQkAaAo2f0rYBa8AAAAASUVORK5CYII=","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Jae","middleName":"Jun","lastName":"Park","suffix":""},{"id":380766651,"identity":"3c5a0e97-509b-4a9f-ba32-d69faa9d19df","order_by":4,"name":"Jung Won Jeon","email":"","orcid":"","institution":"Kyung Hee University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jung","middleName":"Won","lastName":"Jeon","suffix":""},{"id":380766652,"identity":"679e38b1-fce3-42a2-a3b9-039e62fc9a68","order_by":5,"name":"Jae Myung Cha","email":"","orcid":"","institution":"Kyung Hee University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jae","middleName":"Myung","lastName":"Cha","suffix":""}],"badges":[],"createdAt":"2024-11-18 03:53:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5472506/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5472506/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10620-024-08838-3","type":"published","date":"2025-01-13T15:57:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":72299935,"identity":"6417fa43-360f-4080-8c0f-ecd6085a9c52","added_by":"auto","created_at":"2024-12-25 01:15:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":131879,"visible":true,"origin":"","legend":"\u003cp\u003ePatient flow chart\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5472506/v1/e34bd5bf37ad978c2e70b23f.png"},{"id":72299933,"identity":"414517e2-54fc-4ec7-84da-378fdb00c9c0","added_by":"auto","created_at":"2024-12-25 01:15:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85584,"visible":true,"origin":"","legend":"\u003cp\u003eClinical classification of identified gastroduodenal extrinsic compressive lesion\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5472506/v1/b0ebca315832442b8b6b214f.png"},{"id":72299934,"identity":"dc174d46-d43f-4232-bc32-6ab0ed476619","added_by":"auto","created_at":"2024-12-25 01:15:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":516121,"visible":true,"origin":"","legend":"\u003cp\u003eCases of gastroduodenal extrinsic compressive lesion on additional examination\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 3A\u003c/strong\u003e. A 50-year-old male patient had about 3 cm-sized bulging on anterior wall of gastric proximal antrum during upper gastrointestinal endoscopy. The lesion was revealed as the pancreas on CT scan (white arrow).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 3B.\u003c/strong\u003e A 61-year-old male patient was diagnosed with 5 cm-sized extrinsic compression on posterior wall of gastric antrum during upper gastrointestinal endoscopy. The lesion was finally identified as an extrinsic compression by intrahepatic cholangiocarcinoma on CT scan (white arrow).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 3C\u003c/strong\u003e. A 50-year-old male patient had about 3 cm-sized bulging on anterior wall of gastric proximal antrum during upper endoscopy. The lesion was identified as an extrinsic compression by the pancreas on EUS and CT scans (white arrow).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5472506/v1/a671a49f233f98e67e4ea34b.png"},{"id":74284802,"identity":"c8e91901-14ae-446f-a623-f733cbe26a1f","added_by":"auto","created_at":"2025-01-20 16:12:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1452475,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5472506/v1/fd31cf6c-2aa9-4ebc-be13-1743fdb31701.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Associated with Clinically Significant Extrinsic Compression on Gastroduodenal Endoscopy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA luminal protruding lesion covered by normal-appearing mucosa, which is commonly encountered on upper gastrointestinal endoscopy (UGE), can arise from a wide range of non-neoplastic and neoplastic conditions, spanning from a discrete mass originating in any layer of the gastrointestinal wall to extrinsic compression by neighboring structures. Among these, extrinsic compressive lesions caused by structures surrounding the stomach and duodenum can be referred to as gastroduodenal extrinsic compressive lesions (GDECLs). GDECLs are often incidentally identified in asymptomatic patients, and their differential diagnosis ranges from normal variations due to adjacent abdominal structures to pathological lesions caused by neighboring organs or isolated intra-abdominal conditions that require further evaluation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough a significant number of GDECLs are caused by normal variations due to adjacent abdominal structures, clinically significant lesions that require further evaluation or treatment may also be present. Considering this, clinicians often deliberate over the need for additional diagnostic tests when encountering such lesions. However, clear guidelines for assessing the risk associated with these lesions remain lacking [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Currently, various diagnostic modalities, including transabdominal ultrasonography, endoscopic ultrasonography (EUS), computed tomography (CT), and magnetic resonance imaging (MRI), can be considered as additional workups, but these evaluations incur healthcare costs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Given that a considerable portion of GDECLs is likely to be clinically insignificant lesions, such as normal surrounding organs, identifying clinical indicators that assist in the risk stratification of these lesions could guide decisions regarding additional evaluation. Accordingly, the aim of this study is to identify clinical and endoscopic parameters associated with clinically significant GDECLs.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a retrospective, single-center, cross-sectional study. Patients who underwent upper gastrointestinal endoscopy (UGE) at Kyung Hee University Hospital at Gangdong between June 2011 and December 2015 were considered for inclusion. Those with incidentally detected gastroduodenal extrinsic compressive lesions (GDECLs) on UGE were included in the study. The exclusion criteria were as follows: (1) patients who had not undergone at least one additional diagnostic modality, including endoscopic ultrasonography (EUS), computed tomography (CT) scan, transabdominal ultrasonography, or magnetic resonance imaging (MRI); (2) patients with insufficient information; and (3) patients who were ultimately diagnosed with a subepithelial tumor.\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Institutional Review Board of Severance Hospital (IRB number\u0026nbsp;KHNMC 2024-09-016). The requirement for written informed consent from enrolled participants was waived due to the retrospective nature of the study.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical evaluations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this single-center retrospective study, clinical variables and demographic characteristics were collected using self-administered questionnaires. The collected variables included the patient\u0026rsquo;s age, sex, medical history, and the reason for undergoing the initial UGE (e.g., screening or symptom evaluation). Additionally, any symptoms potentially associated with GDECL were also documented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUpper gastrointestinal endoscopy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients underwent at least one upper gastrointestinal endoscopy (UGE) to confirm the presence and location of the GDECL. The UGEs were performed either by a board-certified faculty member affiliated with the gastroenterology department at a university hospital or by a gastroenterology fellow under supervision. Endoscopy reports and images of all patients were reviewed by experienced gastroenterologists to verify the relevant findings. During the procedure, the size, location, and presumptive diagnosis of the GDECL were documented. The location of GDECLs within the stomach was further categorized into the upper, middle, and lower thirds. The size of the GDECL was estimated by measuring the maximum diameter of the compression, using biopsy forceps as a reference for dimension.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional examination after UGE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients underwent at least one additional examination, such as a CT scan, MRI, or EUS, to determine the cause of GDECLs and establish a final diagnosis. The selection of imaging modalities varied by patient and was decided by the attending gastroenterologists. Based on the final diagnosis, patients were categorized into two groups: (1) clinically significant GDECL, referring to lesions that require further treatment or regular follow-up, and (2) clinically non-significant GDECL, referring to normal or benign findings that do not necessitate further diagnostic steps. Clinically significant GDECLs were further subdivided into malignant or benign lesions based on the necessity for appropriate treatment.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables were presented as mean (\u0026plusmn;SD). Clinical characteristics were compared between the significant GDECL and non-significant GDECL groups. Categorical variables were analyzed using chi-square tests or Fisher\u0026rsquo;s exact tests for univariate analysis. Variables found to be significant in the univariate analysis were subsequently included in a multivariate logistic regression to identify independent predictors of clinically significant GDECL. All statistical tests were two-sided, and a \u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue \u0026lt;0.05 was considered statistically significant. All statistical analyses were performed using SPSS for Windows, version 18.0 (SPSS, Inc., Chicago, IL, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter excluding nine patients who were finally diagnosed with subepithelial tumors, 24 patients who lacked further evaluation, and one patient who had undergone subtotal gastrectomy, a total of 73 patients were included in this study (\u003cstrong\u003eFigure 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThe baseline characteristics of the 73 enrolled patients are summarized in Table 1. The mean age at presentation was 56.0 (\u0026plusmn;15.0) years. Among these patients, 29 (39.7%) were male and 44 (60.3%) were female. Regarding comorbidities, the prevalence of hypertension and diabetes mellitus was 19.2% (n=14) and 6.8% (n=5), respectively. Previous extra-abdominal malignancies were present in 5.5% (n=4) of patients, while 4.1% (n=3) had cardiopulmonary disease.\u003c/p\u003e\n\u003cp\u003eThe primary reasons for undergoing initial UGE were screening in 18 patients (24.7%) and non-specific gastrointestinal symptoms in 55 patients (75.3%). Epigastric pain was the most common symptom, prompting 33 patients (45.2%) to undergo UGE. Other symptoms potentially related to the mass effect of GDECL included vomiting in eight patients (11.0%), abdominal distension in seven patients (9.6%), and weight loss in seven patients (9.6%).\u003c/p\u003e\n\u003cp\u003eEndoscopic examinations were performed by gastroenterology faculty members in 48 patients (65.8%) and by medical trainees in 25 patients (34.2%). The mean diameter of GDECLs was 3.4 \u0026plusmn; 1.8 cm. GDECLs were in the stomach in 62 patients (84.9%), and in the duodenum in 11 patients (15.1%). Among the GDECLs located in the stomach, 26 cases (35.6%) were in the upper third, 12 cases (16.4%) in the middle third, and 24 cases (32.9%) in the lower third of the stomach.\u003c/p\u003e\n\u003cp\u003eFor additional examination, EUS was performed in four patients (5.5%), abdominal CT scan in 54 patients (74.0%), transabdominal ultrasonography in 19 patients (26.0%), and MRI in one patient (1.4%). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClassification of gastroduodenal extrinsic compressive lesions (GDECLs) identified by additional examination\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 73 patients, 54 (74.0%) underwent an abdominal CT scan, 19 (26.0%) underwent transabdominal ultrasonography, four (5.5%) underwent EUS, and one (1.4%) underwent an MRI. Following these additional examinations, 23 GDECLs (31.5%) were classified as clinically significant, while 50 GDECLs (68.5%) were classified as clinically non-significant (\u003cstrong\u003eFigure 2\u003c/strong\u003e). Clinically non-significant GDECLs were most commonly confirmed to be normal adjacent organs in 47 cases (64.3%) (\u003cstrong\u003eFigure 3A\u003c/strong\u003e) and simple hepatic cysts in three cases (4.1%).\u003c/p\u003e\n\u003cp\u003eClinically significant GDECLs were further divided into two subgroups: 20 (27.3%) malignant lesions and three (4.1%) benign lesions. The malignant lesions included the following diagnoses: 10 hepatobiliary cancers (\u003cstrong\u003eFigure 3B\u003c/strong\u003e), five peritoneal carcinomatoses, four pancreatic cancers, and one renal cell carcinoma. The benign lesions consisted of two pancreatic pseudocysts and one omental lymphangioma.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with clinically significant GDECLs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e presents the differences between patients with clinically significant GDECLs and those with clinically non-significant GDECLs. In the univariate analysis, the likelihood of clinically significant GDECLs was significantly higher in patients older than 60 years and those with a history of intra-abdominal malignancy (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). Additionally, symptoms of abdominal distension and weight loss were significantly associated with an increased risk of clinically significant GDECLs (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). A large size (\u0026ge;4cm) of extrinsic compression was also significantly associated with the presence of clinically significant GDECLs (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eThe statistical significance of these factors remained consistent in the multivariate analysis (\u003cstrong\u003eTable 3\u003c/strong\u003e). After multivariate adjustment, an age greater than 60 years was associated with a 7.73-fold higher risk of clinically significant GDECLs (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). Similarly, a large size (\u0026ge;4 cm) of GDECLs, symptoms of abdominal distension, and a history of intra-abdominal malignancy were significantly associated with higher risks of clinically significant GDECLs compared to their absence (OR = 7.77, 51.34, and 17.55, respectively; all \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eOther clinical factors, including sex, comorbid medical conditions, the location of GDECL, and the level of experience of the endoscopist, did not show a significant association with the increased risk of clinically significant GDECLs.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this single-center, cross-sectional retrospective study, we identified several clinical factors that are significantly associated with clinically significant GDECL. Advanced age (\u0026gt;\u0026thinsp;60 years), symptoms of abdominal distension or weight loss, a history of intra-abdominal malignancy, and large lesion size (\u0026ge;\u0026thinsp;4cm) were all linked to an increased risk of clinically significant GDECLs. Our findings may assist clinicians in deciding whether to perform additional examinations for incidentally detected GDECLs. These predictive factors could be valuable in risk stratification and guiding appropriate management strategies, potentially reducing unnecessary examinations.\u003c/p\u003e \u003cp\u003eOnly a limited number of studies have investigated the clinical factors associated with GDECLs. Although two previous studies addressed extrinsic compression, they were unable to analyze significant factors due to small sample sizes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. To our knowledge, this is the first study to evaluate the prevalence of GDECLs and identify potential risk factors related to their clinical significance.\u003c/p\u003e \u003cp\u003eOur study found that GDECLs with a maximum diameter greater than 4 cm are significantly associated with the need for clinical treatment (OR\u0026thinsp;=\u0026thinsp;7.77, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This is likely due to the higher malignant potential of larger lesions, as larger compressive masses, such as those seen in hepatobiliary and pancreatic cancers, are often indicative of a more aggressive or advanced disease process. Similar to our study on extrinsic compressive lesions, previous literature on subepithelial tumors (SETs) has also demonstrated that lesion size is a key factor in determining malignant potential of the lesion.\u003c/p\u003e \u003cp\u003ePrevious studies have investigated the association between malignancy potential of GDECLs and age/gender, yet the results have been controversial [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. One study reported that a higher prevalence of comorbidities in elderly patients is associated with an increased risk of extrinsic compression as determined by EUS, but it did not identify any age- or sex-related predictive factors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Our study showed that clinically significant GDECL is not significantly associated with sex, but it is significantly associated with older age (\u0026gt;\u0026thinsp;60 years) The strong association between advanced age and clinically significant GDECLs can be largely explained by the increased prevalence of malignancies in older individuals. As people age, the risk of developing various cancers rises.\u003c/p\u003e \u003cp\u003eAmong various symptoms, abdominal distension was strongly associated with an increased risk of clinically significant GDECL. This association may be due to the direct mass effect of the lesion, leading to physical compression and the sensation of distension. Additionally, abdominal distension may indicate larger, more advanced lesions with higher clinical significance. In malignancies such as peritoneal carcinomatosis, the development of ascites can further contribute to this symptom, underscoring its importance as a potential indicator of serious underlying pathology.\u003c/p\u003e \u003cp\u003eRegarding additional diagnostic modalities for GDECLs, the optimal diagnostic tool has yet to be definitively established. In our study, the following examinations were performed: abdominal CT scan (74.0%), transabdominal ultrasonography (26.0%), endoscopic ultrasonography (5.5%), and magnetic resonance imaging (1.4%), with abdominal CT being the most frequently used. Previous studies reported that US and CT had an accuracy of 19% compared to 100% with EUS for detecting extrinsic compression [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While EUS offers superior resolution for small focal lesions, CT has a significant advantage in assessing the extent of the process and involvement of other organs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although EUS has challenged the primary role of CT or MRI in the differential diagnosis of SET, combining these modalities with EUS can help clarify the nature and extent of the lesion [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Further research is needed to determine the most appropriate additional examinations for incidentally discovered GDECLs.\u003c/p\u003e \u003cp\u003eOur study had several limitations. First, since this was a single-center study, the generalizability of our findings may be limited. Second, there is a possibility that experienced endoscopists might have identified certain extrinsic compressions as definite normal structures, such as the spleen at the great curvature of the upper body and did not record them in the endoscopic report. Third, we were unable to capture cases where the diagnosis changed from subepithelial tumor to extrinsic compression during the course of evaluation. Finally, the retrospective nature of the study means that we were reliant on the accuracy and completeness of existing medical records, which may have introduced some bias. Despite these limitations, our study provides valuable insights that can help clinicians make informed decisions about further examinations in patients with incidentally identified GDECLs.\u003c/p\u003e \u003cp\u003eIn conclusion, although the management strategy for extrinsic compressive lesions detected on UGE remains controversial, additional examinations should be actively considered in patients over the age of 60 years, as well as those with large compressive lesions (\u0026ge;\u0026thinsp;4 cm in maximum diameter), a history of intra-abdominal malignancy, or symptoms of abdominal distension. Proper risk stratification will help better define the optimal management for patients with indeterminate GDECLs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jin Young Yoon, Jin Kyung Bae, Su Bee Park, Jae Jun Park, Jung Won Jeon, and Jae Myung Cha. The first draft of the manuscript was written by Jin Young Yoon and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDisclosures:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHwang, J.H., et al., \u003cem\u003eAmerican Gastroenterological Association Institute technical review on the management of gastric subepithelial masses\u003c/em\u003e. Gastroenterology, 2006. 130(7): p. 2217\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOztas, E., et al., \u003cem\u003eEndosonographic evaluation of patients with suspected extraluminal compression or subepithelial lesions during upper gastrointestinal endoscopy\u003c/em\u003e. Eur J Gastroenterol Hepatol, 2011. 23(7): p. 586\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMotoo, Y., et al., \u003cem\u003eEndoscopic ultrasonography in the diagnosis of extraluminal compressions mimicking gastric submucosal tumors\u003c/em\u003e. Endoscopy, 1994. 26(2): p. 239\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen, T.K., et al., \u003cem\u003eEndoscopic ultrasonography to study the causes of extragastric compression mimicking gastric submucosal tumor\u003c/em\u003e. J Formos Med Assoc, 2001. 100(11): p. 758\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShim, J.J., J.Y. Jang, and R. Chang, \u003cem\u003eAn unusual EUS finding of a gastric extraluminal compression\u003c/em\u003e. Gastrointest Endosc, 2011. 74(2): p. 406\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosch, T., et al., \u003cem\u003eEndosonographic diagnosis of submucosal upper gastrointestinal tract tumors\u003c/em\u003e. Scand J Gastroenterol, 1992. 27(1): p. 1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePonsaing, L.G., et al., \u003cem\u003eDiagnostic procedures for submucosal tumors in the gastrointestinal tract\u003c/em\u003e. World J Gastroenterol, 2007. 13(24): p. 3301\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranco, M.C., R.T. Schulz, and F. Maluf-Filho, \u003cem\u003eOpinion: How to manage subepithelial lesions of the upper gastrointestinal tract?\u003c/em\u003e World J Gastrointest Endosc, 2015. 7(18): p. 1262\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDyrla, P., et al., \u003cem\u003eThe impact of age and sex on the occurrence of pathology in the wall of the upper gastrointestinal tract\u003c/em\u003e. Prz Gastroenterol, 2017. 12(3): p. 192\u0026ndash;198.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapanikolaou, I.S., et al., \u003cem\u003eEndoscopic ultrasonography for gastric submucosal lesions\u003c/em\u003e. World J Gastrointest Endosc, 2011. 3(5): p. 86\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Baseline characteristics of the study population\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eMean (\u0026plusmn;SD) or number (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e56.0 \u0026plusmn; 15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e29 (39.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eIndication of endoscopic exam\u003c/p\u003e\n \u003cp\u003eScreening\u003c/p\u003e\n \u003cp\u003eSymptoms evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (24.7%)\u003c/p\u003e\n \u003cp\u003e55 (75.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eClinical symptoms\u003c/p\u003e\n \u003cp\u003eEpigastric discomfort\u003c/p\u003e\n \u003cp\u003eAbdominal distension\u003c/p\u003e\n \u003cp\u003eWeight loss\u003c/p\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (45.2%)\u003c/p\u003e\n \u003cp\u003e7 (9.6%)\u003c/p\u003e\n \u003cp\u003e7 (9.6%)\u003c/p\u003e\n \u003cp\u003e8 (11.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003cp\u003eCardiopulmonary disease\u003c/p\u003e\n \u003cp\u003ePrevious intra-abdominal malignancy\u003c/p\u003e\n \u003cp\u003ePrevious extra-abdominal malignancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (6.8%)\u003c/p\u003e\n \u003cp\u003e14 (19.2%)\u003c/p\u003e\n \u003cp\u003e3 (4.1%)\u003c/p\u003e\n \u003cp\u003e14 (19.2%)\u003c/p\u003e\n \u003cp\u003e4 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003ePerforming endoscopist\u003c/p\u003e\n \u003cp\u003eFaculty\u003c/p\u003e\n \u003cp\u003eTrainee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48 (65.8%)\u003c/p\u003e\n \u003cp\u003e25 (34.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eMaximum diameter (cm) of compression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e3.4 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eLocation of compression\u003c/p\u003e\n \u003cp\u003eStomach\u003c/p\u003e\n \u003cp\u003eUpper 1/3\u003c/p\u003e\n \u003cp\u003eMiddle 1/3\u003c/p\u003e\n \u003cp\u003eLower 1/3\u003c/p\u003e\n \u003cp\u003eDuodenum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62 (84.9%)\u003c/p\u003e\n \u003cp\u003e26 (35.6%)\u003c/p\u003e\n \u003cp\u003e12 (16.4%)\u003c/p\u003e\n \u003cp\u003e24 (32.9%)\u003c/p\u003e\n \u003cp\u003e11 (15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eAdditional examination\u003c/p\u003e\n \u003cp\u003eEndoscopic ultrasonography\u003c/p\u003e\n \u003cp\u003eAbdominal CT scan\u003c/p\u003e\n \u003cp\u003eTransabdominal ultrasonography\u003c/p\u003e\n \u003cp\u003eMagnetic resonance imaging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (5.5%)\u003c/p\u003e\n \u003cp\u003e54 (74.0%)\u003c/p\u003e\n \u003cp\u003e19 (26.0%)\u003c/p\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eComparison of risk factors between clinically significant and non-significant gastroduodenal extrinsic compressive lesions (GDECLs)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eClinically significant GDECL (n=23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eClinically non-significant GDECL (n=50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eAge \u0026gt;60 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e16 (69.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e16 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eMale gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e8 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e21 (42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.558\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eClinical symptoms\u003c/p\u003e\n \u003cp\u003eEpigastric discomfort\u003c/p\u003e\n \u003cp\u003eAbdominal distension\u003c/p\u003e\n \u003cp\u003eWeight loss\u003c/p\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (52.5%)\u003c/p\u003e\n \u003cp\u003e6 (26.1%)\u003c/p\u003e\n \u003cp\u003e5 (21.7%)\u003c/p\u003e\n \u003cp\u003e5 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28 (56.0%)\u003c/p\u003e\n \u003cp\u003e1 (2.0%)\u003c/p\u003e\n \u003cp\u003e2 (4.0%)\u003c/p\u003e\n \u003cp\u003e3 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.760\u003c/p\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003cp\u003eCardiopulmonary disease\u003c/p\u003e\n \u003cp\u003ePrevious intra-abdominal malignancy\u003c/p\u003e\n \u003cp\u003ePrevious extra-abdominal malignancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (8.7%)\u003c/p\u003e\n \u003cp\u003e5 (21.7%)\u003c/p\u003e\n \u003cp\u003e1 (4.3%)\u003c/p\u003e\n \u003cp\u003e10 (43.5%)\u003c/p\u003e\n \u003cp\u003e3 (13.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (6.0%)\u003c/p\u003e\n \u003cp\u003e9 (18.0%)\u003c/p\u003e\n \u003cp\u003e2 (4.0%)\u003c/p\u003e\n \u003cp\u003e4 (8.0%)\u003c/p\u003e\n \u003cp\u003e1 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003ePerforming endoscopist\u003c/p\u003e\n \u003cp\u003eFaculty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (69.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32 (64.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eLarge size (\u0026gt;4 cm) of extrinsic compression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e17 (73.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14 (28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eLocation of compression\u003c/p\u003e\n \u003cp\u003eStomach\u003c/p\u003e\n \u003cp\u003eUpper 1/3\u003c/p\u003e\n \u003cp\u003eMiddle 1/3\u003c/p\u003e\n \u003cp\u003eLower 1/3\u003c/p\u003e\n \u003cp\u003eDuodenum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (21.7%)\u003c/p\u003e\n \u003cp\u003e4 (17.4%)\u003c/p\u003e\n \u003cp\u003e11 (47.8%)\u003c/p\u003e\n \u003cp\u003e3 (13.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (42.0%)\u003c/p\u003e\n \u003cp\u003e8 (16.0%)\u003c/p\u003e\n \u003cp\u003e13 (26.0%)\u003c/p\u003e\n \u003cp\u003e8 (16.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Multivariate analysis of risk factors for clinically significant gastroduodenal extrinsic compressive lesion (GDECL)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eOdds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eAge \u0026gt;60 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.61-37.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eLarge size (\u0026gt;4 cm) of extrinsic compression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.59-37.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003ePrevious intra-abdominal malignancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e17.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2.55-120.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eAbdominal distension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e51.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2.29-1149.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eWeight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0.223-47.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Extrinsic compression, Endoscopy, Subepithelial lesion","lastPublishedDoi":"10.21203/rs.3.rs-5472506/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5472506/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAlthough clinicians frequently encounter incidentally detected gastroduodenal extrinsic compressive lesion (GDECL) on upper gastrointestinal endoscopy (UGE), optimal management approach for GDECL has not been fully established. This study aimed to stratify and identify important factors associated with clinically significant GDECLs that require regular follow-up or further treatment.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eBetween June 2011 and December 2015, a total of 73 patients with suspected GDECL on UGE at Kyung Hee University Hospital at Gangdong were identified and studied retrospectively. After the final diagnosis, patients were divided into the following two groups: clinically significant GDECL, which requires regular follow-up or further treatment, and clinically non-significant GDECL.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 73 GDECLs, 23 (31.5%) lesions were classified as clinically significant GDECLs and 50 (68.5%) as clinically non-significant GDECLs. Clinical and endoscopic parameters that were associated with clinically significant GDECLs included older age (\u0026ge;\u0026thinsp;60 years) (odds ratio [OR]\u0026thinsp;=\u0026thinsp;7.73, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), large size (\u0026ge;\u0026thinsp;4 cm) of extrinsic compression (OR\u0026thinsp;=\u0026thinsp;7.77, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), previous history of intra-abdominal malignancy (OR\u0026thinsp;=\u0026thinsp;17.55, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and symptoms of abdominal distension (OR\u0026thinsp;=\u0026thinsp;51.34, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSeveral clinical and endoscopic parameters showed significant association with the development of clinically significant GDECLs on endoscopy. These predictive factors might be useful in determining whether to perform further diagnostic work-up in patients with GDECLs.\u003c/p\u003e","manuscriptTitle":"Factors Associated with Clinically Significant Extrinsic Compression on Gastroduodenal Endoscopy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-25 01:15:04","doi":"10.21203/rs.3.rs-5472506/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-21T06:41:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-21T03:20:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17806717329930348908810838884194988517","date":"2024-11-21T02:58:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-19T10:50:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309011896945852399301258832311225910423","date":"2024-11-19T09:36:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-19T02:49:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-18T21:16:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-18T15:47:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Digestive Diseases and Sciences","date":"2024-11-18T03:50:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"86c9a637-7f14-4ec4-9e0a-dfc3d3658318","owner":[],"postedDate":"December 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T16:06:12+00:00","versionOfRecord":{"articleIdentity":"rs-5472506","link":"https://doi.org/10.1007/s10620-024-08838-3","journal":{"identity":"digestive-diseases-and-sciences","isVorOnly":false,"title":"Digestive Diseases and Sciences"},"publishedOn":"2025-01-13 15:57:33","publishedOnDateReadable":"January 13th, 2025"},"versionCreatedAt":"2024-12-25 01:15:04","video":"","vorDoi":"10.1007/s10620-024-08838-3","vorDoiUrl":"https://doi.org/10.1007/s10620-024-08838-3","workflowStages":[]},"version":"v1","identity":"rs-5472506","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5472506","identity":"rs-5472506","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}