Clinicalanalysis Of Endoscopic Submucosal Dissection In The Treatment Of Upper Gastrointestinal Submucosal Protrusion Lesions

Objective: To evaluate the safety and effect of endoscopic submucosal dissection(ESD)in the treatment of upper gastrointestinal submucosal protrusion lesions.To evaluate the diagnostic value of Endoscopic ultrasonography(EUS)in endoscopic submucosal dissection(ESD).Methods:192 patients with upper gastrointestinal submucosal lesions were performed with endoscopic submucosal dissection.Postoperative samples were routinely examined by pathology and immunohistochemistry examinations.The en bloc resection rate was summarized.The complications of bleeding,perforation,and esophageal stenosis were observed.The patient were followed up regularly by endoscopy after treatment.Results: Among the 192 cases,there were 82 cases of esophagus(42.7%),3 cases of cardia(1.6%),37 cases of fundus of stomach(19.3%),41 cases of gastric body(21.4%),2 cases of the angle of stomach(1.0%),21 cases of the antrum of stomach(10.9%),6 cases of duodenum(3.1%).The sizes of resected lesions were 0.3-4.5 cm in diameter.The ESD procedure times ranged from 15 min to 80 min.There were 4 cases of intraoperative perforation(2.1%),3 patients were sutured with clips and cured by conservative treatment,while 1 patient was transferred to surgicallaparoscopic partial repair.5 cases of intraoperative bleeding(2.6%)and2 case of delayed bleeding(1.0%)were occurred during ESD procedures.En bloc resections were 190 cases(98.96%).The coincidence rate of Endoscopic ultrasonography and postoperative pathological diagnosis:access to the pathological cases of 192 cases,158 cases EUS diagnosis and pathologic diagnosis consistent,the rate was 82.29%.The coincidence rate of leiomyoma,GI stromal tumor,lipoma,etopic pancreas,glomus tumor and neoroendocrine tumor(carcinoid)were 93.91%,50%,84.21%,50%,100% and 50%,respectively.Endoscopic ultrasonography can not check out the schwannoma,granular cell tumor and other rare diseases.Layer original coincidence rate was 92.71%.168 cases were followed up for 3-24 months,and were showed no recurrence.Conclusion: It is a safe and effective minimally invasive treatment of submucosal protrusion lesions by endoscopic submucosal dissection guided by endoscopic ultrasonography.Endoscopic submucosal dissection can provide complete pathological evaluation.The perforation rate of ESD for the gastrointestinal submucosal protrusion lesions originated from the muscularis propria was higher.Endoscopic ultrasonography(EUS)can provide evidence for clinical diagnosis and treatment of upper gastrointestinal submucosal protrusion lesions.