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Tissue diagnosis of GI subepithelial tumor only through Trucut biopsy under a forward-viewing endoscope: applicability as newer diagnostic modality



Trucut biopsy (TCB) has been proposed to overcome the limitations of endoscopic ultrasonography (EUS)-guided fine-needle aspiration for the pathologic diagnosis of upper gastrointestinal (GI) subepithelial tumor (SET); however, it can be difficult to perform because the Trucut biopsy needle is very stiff. Although technical failures have been reported with the use of TCB, recently the forward-viewing echoendoscope showed a high diagnostic accuracy. We hypothesized that TCB under a conventional forward-viewing endoscope can be applied with higher yield of tissue diagnosis.


To evaluate the feasibility of TCB under a forward-looking endoscopy without cumbersome EUS guidance, we introduced a 19-gauge TCB needle into the working channel of a conventional upper endoscope in 27 patients with GI SET to make tissue diagnosis. Prospectively collected data were analyzed, including technical success rate, pathologic result, and adverse events.


Twenty-seven patients with GI SET (18 esophageal tumors and nine gastric tumors) underwent TCB under a forward-looking endoscope. All procedures were performed safely without any TCB-related complications. Subsequently, histopathology examination revealed gastrointestinal stromal tumors (GISTs) in three cases and leiomyomas in 21 cases. Histologic assessment was completed in 24 out of 27 patients (88.9 %) because tissue obtained from three patients, whose tumors were located in the stomach, was not sufficient for the pathologic diagnosis.


TCB using a conventional forward-viewing endoscope without EUS guidance provided an excellent pathologic diagnosis of upper GI SET.

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Correspondence to Joo Young Cho.

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Weon Jin Ko, Ga Won Song, Ki Baik Hahm, Sung Pyo Hong, Joo Young Cho, Jun-Hyung Cho, and So Young Jin have no conflicts of interest or financial ties to disclose.

Ethical standard

This study was conducted in accordance with the ethical standards of the Declaration of Helsinki 1964, as revised in 2013.

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Video 1

Trucut biopsy using a forward-viewing endoscope without endoscopic ultrasonography guidance for the diagnosis of esophageal subepithelial tumors (WMV 10538 kb)

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Ko, W.J., Song, G.W., Hahm, K.B. et al. Tissue diagnosis of GI subepithelial tumor only through Trucut biopsy under a forward-viewing endoscope: applicability as newer diagnostic modality. Surg Endosc 30, 5009–5014 (2016).

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  • Trucut biopsy
  • Subepithelial tumor
  • Forward-viewing endoscope