What is the appropriate workup for an epigastric mass?

From the Guidelines

The appropriate workup for an epigastric mass should begin with a thorough history and physical examination, followed by laboratory tests and imaging studies, with the most recent guidelines recommending a contrast-enhanced CT scan of the abdomen and pelvis, and upper endoscopy (EGD) with biopsy, as outlined in the 2022 guidelines 1. The workup for an epigastric mass is crucial in determining the underlying cause, which can range from benign processes to malignancies.

• A thorough history and physical examination are essential in identifying symptoms and signs that may guide further investigations.
• Laboratory tests, including complete blood count, liver function tests, amylase, lipase, and tumor markers such as CEA and CA 19-9, can provide valuable information on the possible cause of the epigastric mass.
• Imaging studies are critical in the workup of an epigastric mass, with a contrast-enhanced CT scan of the abdomen and pelvis being the recommended initial imaging test, as it can provide detailed anatomical assessment and help identify potential causes such as gastric cancer, gastrointestinal stromal tumors (GISTs), or other malignancies 1.
• Upper endoscopy (EGD) with biopsy is also recommended, as it allows for direct visualization and sampling of any gastric or duodenal masses, and can help establish a definitive diagnosis 1.
• Further characterization with MRI, endoscopic ultrasound (EUS) with fine needle aspiration, or other tests may be necessary, depending on the initial findings and suspected causes of the epigastric mass.
• The workup should be guided by the most recent guidelines, which emphasize the importance of a systematic approach in evaluating epigastric masses, as outlined in the 2022 guidelines 1.
• It is essential to note that the workup may vary depending on the specific clinical context and suspected causes of the epigastric mass, and should be individualized based on patient factors and clinical judgment.
• The 2025 guidelines for gastrointestinal stromal tumors (GISTs) also emphasize the importance of mutational analysis and molecular testing in the diagnosis and management of GISTs 1.
• Overall, a thorough and systematic workup, guided by the most recent guidelines and individualized based on patient factors, is essential in determining the underlying cause of an epigastric mass and guiding further management.

From the Research

Epigastric Mass Workup

The workup for an epigastric mass involves a combination of imaging studies and diagnostic procedures to determine the cause and extent of the mass.

• Imaging studies such as computed tomography (CT) and positron emission tomography (PET) are commonly used to evaluate the mass and detect any potential metastases 2.
• CT scans can provide detailed images of the mass and surrounding tissues, while PET scans can help identify areas of high metabolic activity, which may indicate cancer 2.
• In some cases, staging laparoscopy may be used to evaluate the mass and detect any potential metastases in the abdominal cavity 3.

Diagnostic Procedures

• Endoscopic ultrasound (EUS) may be used to evaluate the mass and determine its proximity to surrounding tissues and organs 4.
• Biopsy may be performed to obtain tissue samples for histopathological examination and determine the nature of the mass.
• In cases where a gastrointestinal stromal tumor (GIST) is suspected, immunohistochemical staining and genetic examination may be performed to confirm the diagnosis 5, 6.

Treatment

• The treatment approach for an epigastric mass depends on the underlying cause and extent of the mass.
• In cases where a GIST is diagnosed, neoadjuvant imatinib treatment may be used to shrink the tumor and make it more amenable to surgical resection 5, 6.
• Surgical resection may be performed to remove the mass, and adjuvant chemotherapy may be used to prevent recurrence 6.