Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastroenterol. Sep 28, 2026; 32(36): 119724
Published online Sep 28, 2026. doi: 10.3748/wjg.119724
Published online Sep 28, 2026. doi: 10.3748/wjg.119724
Natural history of asymptomatic subepithelial lesions of the upper gastrointestinal tract: A multicenter study in Korea
Yonghoon Choi, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
Jae Yong Park, Sang Hoon Kim, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 06973, South Korea
Sung Eun Kim, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea
Jae Myung Park, Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, South Korea
Joon Sung Kim, Seung Woo Lee, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul 06591, South Korea
Hyunsoo Chung, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
Seung Han Kim, Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Seoul 08308, South Korea
Chan Hyuk Park, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
Seon-Young Park, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju 61469, South Korea
Bong Eun Lee, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Ayoung Lee, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, South Korea
Jeong Hoon Lee, Hwoon-Yong Jung, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Da Hyun Jung, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, South Korea
Hyeong Ho Jo, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu 42472, South Korea
In Hyuk Yoo, Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Byung-Hoon Min, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Co-first authors: Yonghoon Choi and Jae Yong Park.
Author contributions: Choi Y and Park JY contributed equally to this study as co-first authors. Choi Y and Park JY were responsible for manuscript writing, data collection, data analysis, study conception, participated in the design of the study, data interpretation, and project coordination; Kim JS, Chung H, Kim SH, Park CH, Kim SH, Park SY, Lee BE, Lee SW, Lee A, Lee JH, Jung DH, Jo HH, Yoo IH, and Min BH were responsible for data collection, data analysis, participated in study design and assisted in revising the manuscript; Kim SE, Park JM, and Jung HY were responsible for project administration, data analysis, study conception, participated in the design of the study, supervision; and finalization of the draft.
AI contribution statement: No AI tool was involved in the generation of research data, interpretation of results, manuscript writing, or formulation of conclusions.
Supported by the Korean College of Helicobacter and Upper Gastrointestinal Research Foundation Grant, No. KCHUGR-202302502.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Seoul National University Bundang Hospital, approval No. B-2311-864-104, and the study was performed in accordance with the Helsinki II declaration.
Informed consent statement: Written informed consent was waived by the Institutional Review Board, owing to the retrospective design.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Data are provided within the manuscript or Supplementary material.
Corresponding author: Sung Eun Kim, Department of Internal Medicine, Kosin University College of Medicine, 262, Gamcheon-ro, Seo-gu, Busan 49267, South Korea. solefide@hanmail.net
Received: February 4, 2026
Revised: March 10, 2026
Accepted: May 6, 2026
Published online: September 28, 2026
Processing time: 199 Days and 1.8 Hours
Revised: March 10, 2026
Accepted: May 6, 2026
Published online: September 28, 2026
Processing time: 199 Days and 1.8 Hours
Core Tip
Core Tip: In this large multicenter cohort of asymptomatic upper gastrointestinal subepithelial lesions (SELs), long-term follow-up demonstrated a low cumulative risk of progression, with a 5-year risk of only 1% for intervention and 4% for significant (≥ 25%) size increase. Younger age, larger baseline size, mucosal erosion, and heterogeneous echogenicity were associated with lesion growth, whereas the rolling sign was protective. These findings support conservative management with less intensive surveillance for SELs < 3 cm without high-risk features.