ArticleClinical endoscopy2026
Upfront unroofing of subepithelial lesions using cold snare in the upper and lower gastrointestinal tract: a retrospective study from Switzerland.
Article in Clinical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundSubepithelial lesions (SELs) are frequently encountered in the upper and lower gastrointestinal (GI) tracts during routine endoscopy. As a significant proportion of SELs harbor malignant potential, a definitive diagnosis with tissue sampling should be sought in most patients. However, small SELs (<20 mm) represent a clinical challenge because endoscopic ultrasound-guided tissue acquisition may not be as efficient under these circumstances. Furthermore, mucosal incision biopsies require equipment that is not universally available.
methodsWe retrospectively investigated the diagnostic yield and safety of cold snare unroofing in an observational cohort.
resultsA total of 71 SELs (41 in the upper GI tract and 30 in the lower GI tract) with a median size of 10 mm (range, 3-60 mm) were included. Unroofing resulted in a histologic diagnosis in 85% (n=60) of cases, with no further diagnostic procedures or surveillance required in 88.3% (n=53/60). The final diagnoses consisted of 10 different etiologies, including three GI stromal tumors, one neuroendocrine tumor, and 44 lipomas. No significant complications, such as bleeding or perforation, were observed.
conclusionsCold snare unroofing represents an efficient and easy method for characterizing small SELs in the upper and lower GI tracts, offering a valuable alternative to mucosal incision-assisted biopsy (MIAB) and endoscopic ultrasound with fine-needle biopsy.
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