| Objective:1.To understand the clinical characteristics of submucosal elevated lesions of the upper gastrointestinal tract in a tertiary hospital in Xi’an,and to explore the guiding value of endoscopic ultrasonography(EUS)in the diagnosis and treatment of submucosal elevated lesions of the upper gastrointestinal tract.2.To explore the value of EUS combined with gray histogram in the differential diagnosis of Gastrointestinal Stromal Tumor(GIST)and leiomyoma.3.To Screen EUS characteristic factors for predicting risk stratification of GIST.Methods: The clinical data of 169 patients who underwent EUS examination in Shaanxi Provincial People’s Hospital from October 2017 to March 2021 and were pathologically diagnosed as submucosal raised lesions of the upper gastrointestinal tract were retrospectively analyzed.The accuracy of diagnosis of sexual lesions and the value of treatment guidance.The clinical features and EUS characteristics of gastrointestinal stromal tumor and leiomyoma were analyzed,and the EUS combined with grayscale was compared by t-test.Further focus on screening the factors affecting the risk stratification of gastrointestinal stromal tumors,constructing a model for predicting the risk stratification of GIST,and analyzing the predictive value of risk factors for the invasiveness of gastrointestinal stromal tumors。Results:1.Among the 169 patients,84 cases of males and 85 cases of female.The age of onset was 23-88 years old,and the average age of onset was 57.91±12.26 years old,High incidence age is 50-65 years old.Most of the patients were asymptomatic and the size of the lesion was <1cm.The lesions were mainly distributed in the stomach(67.5%),followed by the esophagus and duodenum.Submucosal tumors are mainly gastrointestinal stromal tumors in the stomach,leiomyomas in the esophagus,and cysts in the duodenum.Gastrointestinal stromal tumor and leiomyoma were the main lesions,accounting for 42.0% and 23.1%,respectively.2.The diagnostic accuracy of EUS was 67.5% and 87.9% in qualitative and determination of the origin of lesions,respectively.In this group,120 cases,accounting for 71%,underwent endoscopic treatment,of which Endoscopic Submucosal Excision(ESE)was the main treatment option in 42 cases.According to EUS,the submucosal tumor originated from the muscularis propria and underwent ESE.Endoscopic mucosal dissection is performed for submucosal tumors originating from the muscularis mucosa and the size of the submucosa is 0.2-2.5 cm.Endoscopic mucosal resection is performed for submucosal tumors originating from the muscularis mucosae with a size of <2 cm.3.There were 35 cases of leiomyoma and 61 cases of gastrointestinal stromal tumor in this study,and the male to female ratio was 0.92:1.Gastrointestinal stromal tumors were most common in the stomach,accounting for 82.0%;leiomyomas were most common in the esophagus,accounting for 65.7%;in this group,gender(P <0.001),age(P<0.001),size and(P=0.012),distribution location(P <0.001),echo intensity(P=0.003),echo uniformity(P<0.001),shape(P=0.047),boundary(P=0.028),surface ulcer(P=0.001),mean gray value(P=0.016)and standard deviation(P=0.002)were statistically significant in the identification of gastrointestinal stromal tumors and leiomyomas(P < 0.05).4.Among the 61 cases of gastrointestinal stromal tumors,36 cases(59%)in the low-risk group and 25 cases(41%)in the high-risk group,the tumor length and diameter(P =0.005),the level of origin(P =0.026),growth pattern(P =0.046),and surface ulcers(P=0.001)were significantly different between the low-risk group and the high-risk group(P < 0.05).In this study,we found that the larger the length,the deeper the origin,the growth pattern,and the ulceration of gastrointestinal stromal tumors were related to the degree of invasion.Multivariate logistic regression analysis showed that the long diameter of gastrointestinal stromal tumors(OR=1.900;95%CI,1.012-3.567,P=0.046)was an independent risk factor for predicting the malignant potential of tumors,when the optimal cut-off value was 1.5cm,the area under the ROC curve was 0.75(95%CI:0.623-0.877),the sensitivity was 68%(95% CI: 0.465-0.851),and the specificity was75%(95% CI: 0.578-0.879).Conclusion:1.The submucosal elevated lesions of the upper gastrointestinal tract are more common in middle-aged and elderly people,and there is no gender difference between men and women,and most of them are asymptomatic.Gastric stromal tumors and esophageal leiomyomas are the most common lesions.EUS can accurately analyze submucosal tumors,which is conducive to the selection of endoscopic treatment methods.2.EUS and grayscale histogram are expected to become a new method to identify gastrointestinal stromal tumors and leiomyomas.3.Gastrointestinal stromal tumors with different invasion risk stratification have different performances in EUS images,and the model constructed by tumor length has good diagnostic performance in predicting the degree of invasion of GISTs. |
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