Novel transoesophageal application of EBUS-guided cryobiopsy for diagnosis of a gastric subepithelial lesion

Authors

• Rahaf A. Jereisat Department of Internal Medicine, University of Houston/ HCA-Clear Lake, Houston, USA
• Nawras Ibrahim Department of Internal Medicine, University of Houston/ HCA-Clear Lake, Houston, USA 0009-0000-7266-0364
• Ya Xu Department of Internal Medicine, University of Houston/ HCA-Clear Lake, Houston, USA
• Maher Dahdel Department of Internal Medicine, University of Houston/ HCA-Clear Lake, Houston, USA

rahaf.jereisat@hcahealthcare.com

Keywords

Abstract

Background: Gastrointestinal subepithelial lesions (SELs) arising from the muscularis propria pose diagnostic challenges, particularly paucicellular tumours such as leiomyomas, which frequently yield insufficient tissue on endoscopic ultrasound -guided fine-needle biopsy (EUS-FNB). Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) achieves superior diagnostic yield over conventional needle aspiration by obtaining intact tissue cores that preserve histologic architecture. Transoesophageal cryobiopsy has been reported for mediastinal lymph node sampling but has not been applied to gastrointestinal wall lesions.
Case report: A 50-year-old man presented with a progressively enlarging gastroesophageal junction mass originating from the muscularis propria (70 x 52 mm). Two EUS-FNB sessions (eight total passes with 19-, 22-, and 25-gauge needles) yielded only scant paucicellular smooth muscle fragments insufficient for definitive diagnosis. Positron emission tomography/computed tomography scan demonstrated fluorodeoxyglucose avidity (SUV_max 6.6), raising concern for malignancy. After the patient declined surgical excision and mucosal incision-assisted biopsy referral, transoesophageal cryobiopsy was performed using an EBUS bronchoscope with a 1.1 mm CO₂ cryoprobe advanced through the oesophageal wall under ultrasound and fluoroscopic guidance. Cryobiopsy yielded tissue fragments up to 0.4 cm with preserved architecture. Immunohistochemistry confirmed leiomyoma (SMM+, desmin+, DOG1-, c-kit-, S100-, CD34-), excluding gastrointestinal stromal tumour. The patient developed a post-procedural sterile inflammatory response (C-reactive protein 188.2 mg/l) requiring 3-day hospitalization; imaging excluded perforation. He remains asymptomatic at 3-month follow-up.
Conclusion: Transoesophageal EBUS-guided cryobiopsy can provide diagnostic tissue from gastric subepithelial lesions refractory to standard EUS-FNB. However, the significant inflammatory response underscores the need for systematic safety evaluation, beginning with animal model studies, before broader clinical application.

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