| Objective:To explore the clinical value of endoscopic ultrasonography(EUS) in the diagnosis， differential diagnosis and treatment of uppergastrointestinal submucous lesions. To understand the predilection sites,nature and sources of upper gastrointestinal submucosal lesions by endoscopicultrasound. Through the combination of ultrasound diagnosis and pathologicdiagnosis, we can provide the basis for further treatment options.Method: We collected366cases of upper gastrointestinal submucouslesions, which were evaluated by endoscopic ultrasonography from May2009to January2013in our department. This diagnostic modality providesinformation about the lesion location (esophagus, stomach and duodenum)，thesize, echo performance (such as high echo, iso-echoic, low echo, no echo,mixed echo), layer of origin (mucosal,muscularis mucosa layer, submucosa,muscularis propria and serosal layer),boundary (clear, not clear) and lesioninvasion situation around. The different therapeutic methods are chosenaccording to the size, rigion, location of submucous apophysis lesions. Theclinical treatments are including follow-up, endoscopic treatment (Transparentcap ligation, EMR, ESD, cyst fenestration), surgery (gastroscope combinedlaparoscopic, laparoscopy and laparotomy). Make a record of successful cases,size of the mass and layer of origin (mucosal,muscularis mucosa layer,submucosa, muscularis propria and serosal layer), The consistency betweenendoscopic ultrasonography and pathological diagnosis, complications(bleeding, perforation)and transit surgery or not.Results:1Diagnostic result:There are366patients with upper gastrointestinal submucous lesionswere examined by EUS, of which170were male,196were female. The median age is51years, range from11to79.313(85.6%) cases of uppergastrointestinal lesions are regioned from the intramural, and53(14.4%) casesof lesions are caused by external pressure. The upper gastrointestinal lesionsinclude118(32.2%) cases of leiomyoma, and104(28.4%) cases of stromaltumors,17(4.6%) cases of lipoma,2(0.5%) cases of venous tumor,19(4.9%)cases of cyst,31(8.5%) cases of ectopic pancreas,2(0.5%) cases of carcinoma.Stromal tumor is mainly come from gastric fundus, there are49(47.1%) cases.It mainly originated from muscularis propria, which are68(65.4%) cases,followed by muscular membrane27(26.0%) cases. Low echo lesions are98(94.2%) cases, and echo uniform lesions are70(67.3%) cases. Leiomyomais mainly come from esophageal, there are110(93.2%) cases. There are58(49.2%) cases derived from mucosal muscularis. There are48(40.7%) casescome from muscularis propria48(40.7%) cases.115(97.5%) cases are lowecho.98(82.2%)cases are echo uniform. Lipoma is mainly come from gastriccavity, there are10(58.8%) cases.15(88.2%) cases are derived from thesubmucosa.15(94.1%) cases are high echo.11(64.7%) cases are echo uniform.Ectopic pancreas mainly come from gastric antrum, there are30cases(96.8%).31cases (100%) come from submucosa.25cases (80.6%) are mixedecho.29cases (93.5%) are echo nonuniform.2Treatment results:The treatments of upper gastrointestinal submucous lesions includeTransparent cap ligation, EMR, ESD and surgery.2.1Transparent cap ligation or endoscopic band ligation: there are74cases ofupper gastrointestinal submucous lesions applied ligation.31cases are locatedin muscularis mucosa layer and the diameter＜1.5cm; One case with adiameter of2.5cm.29cases are located in muscularis propria and thediameter range from0.3to1.5cm.3cases are failed and the success rate ofligation is95.9%(71/74).17cases took electricity cut method to get tissue forpathologic analysis.2case end up with perforation.1case was clipped.1casewas resected by surgery.2.2There were3cases were treated by EMR, which come from the mucosa and submucosa, size <1cm. The success rate is100%. No single case hadsevere complications, but the surface of the wound in one case was large,which was closed with clips.2.3There are32cases were treated by ESD，with1case coming fromesophagus and2cases coming from stomach.5cases were derived frommuscularis propria, with the size range from0.5cm to2cm.2cases werefailed.14cases were from submucosa, with the size ranging from0.5cm to5cm,1cases failed.13cases were from mucosal muscularis, with the sizeranging from0.5cm to1.5cm, and all were succeed.So the total success rateof ESD was90.6%(29/32), but1cases turned up with bleeding duringoperation, which were used endoscopic spray drugs, electric coagulation andclips to hemostasis. No perforation or postoperative bleeding.10cases weretreated by surgery, and its size range from2.0cm to7.0cm.The success ratewas100%.1case of cyst with the size of0.6cm was treated by cystfenestration, which located in esophagus, and came from mucosal muscularis.The operation was successful.3Coincidence rate between endoscopic ultrasound imaging and histopathology for the diagnosis of upper gastrointestinal submucous lesion.120cases were treated with EUS.65cases got pathological diagnosis,including biopsy or resection after ligation, EMR, ESD and surgery. Thepostoperative histological results of65patients were compared with thepreoperative diagnosis of EUS, the total diagnostic accuracy is86.2%. Thediagnostic accuracy of leiomyoma is92.6%.The diagnostic accuracy ofstromal tumor is95.0%. The diagnostic accuracy of lipoma is100%. Thediagnostic accuracy of ectopic pancreas is77.8%. The diagnostic accuracy ofcysts is50%.Conclusions:1The coincidence rate of EUS diagnosis and pathological diagnosis is86.2%. EUS can clearly show size, source, the echo characteristics of thelesions and whether the change is external pressure lesions or not. Endoscopic ultrasonography is the best way to diagnosis upper gastrointestinal submucous lesions, such as Leiomyoma, stromal tumors, ectopicpancreas cyst, lipoma, hemangioma.2Under the endoscopic ultrasound guidance, select right endoscopictreatment of the upper gastrointestinal submucous lesions, such as transparentcap ligation, EMR, ESD. The success rate is greater than90.6%. According toEUS, endoscopic treatment of submucous lesions is safe, effective, and withfewer complications. |
PDF Full Text Request