The Diagnostic Approach of Benign Esophageal Tumors: A Narrative Review

Benign esophageal tumors (BETs) pose diagnostic challenges due to overlapping clinical and imaging features, necessitating advancements in diagnostic techniques. Distinguishing between tumors with and without malignant potential is essential to guide management. We aim to review the diagnostic approach to BETs with an emphasis on recent advances.

EUS-guided tissue acquisition is the current gold standard, particularly in subepithelial lesions (SELs). EUS with fine-needle biopsy (FNB) is considered superior to fine-needle aspiration (FNA), unless rapid on-site evaluation (ROSE) is available. The influence of needle size and suction technique has limited impact on the tissue sample quality. Mucosal-incision–assisted biopsy aims to improve diagnostic yield for smaller SELs and improve accessibility of diagnostic techniques. Recent studies assessing integration of artificial intelligence have shown promise in improving diagnostic accuracy.

Retrospective data shows promise for technologies intended to improve both non-invasive and invasive modalities for the diagnosis of BETs. Future research should aim to prospectively explore these strategies and include lesions throughout the gastrointestinal tract.