Diagnostic Value Of Eus In 270 Cases Of Submucosal Tumors Of Upper Gastrointestinal Tract

Objective:To explore the predilection sites and EUS manifestations for each type of SMT.To discuss the values of EUS for SMT via endoscopic treatments and postoperative pathological diagnosis,and attempt to guide the endoscopic treatments for the types of SMT.Method:In this study,270 patients diagnosed with SMT were enrolled after general gastroscopy examinations.All these data are catagorized from The First Affiliated Hospital of Guangxi Medical University during the 5-year period extending from 1 January 2012 to 31 December 2016.General information(Name,Gender,Age,Examination Date,Tel Number,etc),EUS Results(Location,Layer,Echo Features)were analysed as well as whether treated by endoscopy or surgeon,treatment records and postoperatibe pathological diagnosis.Results:1.In total,270 patients formed the study population.As for SMT location,108 subjects(40.00%)came from Esophagus,5 subjects(1.85%)came from cardia,145 subjects(53.70%)came from stomach and 12 subjects(4.44%)came from duodenum.The pathological changes of esophagus mainly come from the muscularis mucosae and muscularis propria while the major type is leiomyoma.The main pathological changes of the stomach were from the submucosa and muscularis propria.The main types of lesions were stromal tumors and ectopic pancreas.The common echo of leiomyoma is homogeneous and hypoechoic mass,which is common in the muscularis propria and muscularis propria.The common echo of stromal tumors showed homogeneous and hypoechoic masses,which were mainly from the muscularis propria and that of ectopic pancreas is inhomogeneous and hypoechoic mass,which is common in the submucosa.2.Treatments of SMT and pathological diagnosis analysis:As for these 270 subects,the EMR was performed in all of the 45 cases,ESD in 54 cases and 3 cases were treated by STER.Among them,67 cases of SMT size was less than lcm,and the SMT size of 38 cases was from 1 to 3 cm.EMR complicated with hemorrhage in 1 case(2.22%).ESD complicated with hemorrhage in 1 case(1.85%)and perforation in 5 cases(9.26%).In this group,the coincidence rate of EUS diagnosis and pathologic diagnosis of leiomyoma was 89.06%,stromal tumors rate was 53.13%and that of ectopic pancreas was 52.63%.Among them,14 cases were diagnosed by pathology,neuroendocrine carcinoma in 1 cases,and precancerous lesion in 4 cases while the EUS diagnosis of these cases is not consistent with the diagnosis by pathology.Conclusions:1.EUS can make diagnosis via explorations of submucosal tumor lesion,lesion size,source level,echo level and whether echo is well-distributed or not and so that it could provide guidance for endoscopic treatment options.2.Considering the SMT diagnosis,the coincidence rate of EUS and Pathology is 72.88%,while limitations still exist in diagnosis with upper gastrointestinal submucosal inflammation,precancerous lesion and malignant tumors.