Miniprobe Endoscopic Ultrasound In Combination With Endoscopic Submucosal Dissection For Diagnosis And Treatment Of Submucosal Protuberant Lesion In Gastrointestinal Tract

Objective：To discuss the diagnostic value of miniprobe endoscopic ultrasonography(mEUS) in submucosal protuberant lesion. To assess the clinical efficacy and safetyof ESD under the guidance of mEUS in the treatment of the gastrointestinalsubmucosal lesion.Methods：We chose383patients who had received the miniprobe endoscopicultrasonography and diagnosed as gastrointestinal submucosal lesions, and hadaccepted the ESD treatment at the First Affiliated Hospital of Nanchang Universityfrom January2008to december2012. Recorded the site, size, origin, echo,boundary, the results of endoscopic ultrasonography diagnosis, ESD pathologicaldiagnosis results and complications of ESD of each submucosal lesions. To analysethe characteristics of submucosal lesions of the disease spectrum, the accuracy of thediagnosis of mEUS and ESD pathology for the gastrointestinal submucosal lesions,and the complications of ESD.Results：1. In this study, a total of383gastrointestinal submucosal protuberant lesion, themost common location was stomach, accounted for78.5%(301/383), followed by theorder was esophagus, colon and duodenum, accounted for12.7%(47/383),8.6%(33/383) and0.5%(2/383) respectively. The most common lesion was leiomyoma,accounted for33.1%(127/383). Followed by the order was stromal tumors, ectopicpancreas, neuroendocrine tumor, lipoma, which accounted for22.4%(86/383),21.1%(81/383),9.7%(37/383),6.8%(26/383) respectively. Distribution in the muscularismucosal lesions was mainly leiomyoma, which accounted for64.5%(40/62).Distribution in the submucosa lesions was mainly ectopic pancreas, neuroendocrinetumor and lipoma, which accounted for49.3%(72/146),18.5%(27/146),17.8%(26/146). Distribution in the muscularis propria lesions was mainly leiomyoma andstromal tumors, which accounted for48%(84/175),45.1%(79/175). 2. The overall accuracy rate of miniprobe endoscopic ultrasonographydiagnosis of gastrointestinal submucosal lesions was67.9%(260/383). The AUC ofminiprobe endoscopic ultrasonography for lipoma, neuroendocrine tumor,gastrointestinal stromal tumor, ectopic pancreas and leiomyoma was0.990、0.925、0.819、0.726and0.669.3. A total of383cases of ESD patients, which one-time complete resection was364cases (95%) and partially was19cases (4.9%). The total complication rate ofESD was13.3%(51/383). The incidence of blood loss was7.3%(28/383), whichgiven treatment are improved, no postoperative bleeding happens. Intraoperativeperforation was23cases (6%),22patients recovered after conservative treatment,1cases of perforation was not closed and transferred surgery.Conclusion：Miniprobe endoscopic ultrasonography have a good diagnosis effect forsubmucosal protuberant lesion in gastrointestinal tract, and can guide the choice oftreatment of submucosal lesions. ESD is the effective and safe treatment method forthe submucosal lesions of gastrointestinal tract under the guidance of the endoscopicultrasonography. They also can obtain the histopathologic diagnosis.