Evaluation Of Clinical Treatment For Submucosal Tumors Of Upper Gastrointestinal Tract

Part 1 Endoscopic method and evaluation for submucosal tumors of upper gastrointestinal tractBackground:Submucosal tumors(SMT) are common in the upper gastrointestinal tract. Surgical resection used to be the only received treatment.With the development of the techniques,endoscopic resection has been used in the treatment of the SMTs.Objective:The aim of this study is to evaluate the value and safety of different treatmen for SMT in the upper gastrointestinal tract.Methods:A total of 332 patients with SMTs in the upper gastrointestinal tract in Shanghai Zhongshan hospital from Jan.2006 to Jan.2009 were retrospectively analyzed.All the patients were divided into two groups depending on the different treatments.Results:Among endoscopic nylon ligation group:146 patients with SMTs were followed. 119 patients were reassessed by endoscopy.79 of them were found of no lesions;34 of them were found smaller lesions,15 of them were performed EMR and 5 were performed ESD.The effective rate was 75.3%Among ESD group:186 patients were performed by ESD.4 patients were suggested to have surgery.146 patients were reassessed by endoscopy.139 of them were found of no lesions.The effective rate was 80.2%Conclusion:Compared this two endoscopic methods to treat SMTs,we found that ESD has higher effective rate than nylon ligation and more complications. Part 2:Prognostic factors of gastrointestinal stromal tumorsBackground:Gastro-intestinal stromal tumours(GISTs) are rare tumours of the gastro-intestinal(GI) tract,mesentery,and omentum.Nonetheless,malignant GIST is the most common sarcoma of the GI tract and accounts for 5%of all sarcomas.1 The estimated annual incidence is 10 to 20 cases per million,of which 20 to 30%are malignant.2 There is long-standing confusion and controversy regarding their origin, differentiation,nomenclature,diagnosis,and prognosis.Objective:To evaluate the prognostic factors of GIST and provide the evidence for the treatment.Result:Among Endoscopy group:There are 28 cases in this group were diagnosed as GIST by pathology finally.CD117 is positive in 18 cases,positive rate is 64.3%; CD34 is positive in 16 cases,positive rate is 57.1%;SMA is positive in 5 cases, positive rate is 17.9%;desmin is positive in 2 cases,positive rate is 7.1%;S-100 is positive in 4 cases,positive rate is 14.3%;MSA is negative in all cases.;nestin is positive in 8 cases,positive rate is 28.6%.Among Surgery group:There are 90 cases in this group were diagnosed as GIST by pathology finally.CD117 is positive in 78 cases,positive rate is 86.7%;CD34 is positive in 82 cases,positive rate is 91.1%;SMA is positive in 12 cases,positive rate is 13.3%;desmin is positive in 2 cases,positive rate is 2.2%;S-100 is positive in 20 cases,positive rate is 22.2%;MSA is positive in 5 cases,positive rate is 5.6%.; nestin is positive in 61 cases,positive rate is 67.8%.Conclusion:The surgery group has higher recurrence rate than the endoscopic group.The malignant degree is asscociated with immunohistochemistry results of GISTs such as CD117,CD34,desmin and S-100.But CD117 maybe is the independent risk factor.