Clinical Value Of Endoscopic Ultrasonography For Esophageal Leiomyoma In Elder Patients

Background:Leiomyoma is a benign tumor. As reported, it is rare,1% of all esophageal tumors,but it is the most common of benign tumors (about 70%) of the esophagus. Around 90% of cases occur in patients between the ages of 20 and 70 years. It is still unknown about how esophageal leiomyoma occurs. More than half of patients with esophageal leiomyoma can remain asymptomatic, when symptoms arise they are usually in the form of dysphagia, epigastric pain, retrosternal pain, and dyspepsia, but these are not specific for the disease, potentially causing diagnostic confusion. Endoscopic ultrasonography (EUS) can clearly reveal the five layered structure of the gastrointestinal wall, and thereby define the nature, size, number, and originating layer of the lesions. Therefore, EUS is a valuable technique for diagnosis and determining treatment of esophageal leiomyoma. Treatment for esophageal leiomyoma depends on multiple factors, including tumor size, location and the patient’s symptoms and overall conditions. Asymptomatic patients can be monitored by radiography and endoscopy. Indications for surgical treatment include unremitting symptoms, progressive increase in tumor size, mucosal ulceration, the need to obtain histopathologic diagnosis, and facilitation of other esophageal procedures. As promotion of endoscopy and EUS, the prevalence of esophageal leiomyoma in elder patients is increasing, but researches about management of esophageal leiomyoma in elder patients are rare. Because of the characteristics about elder patients, the study concerns on the ability of EUS for making diagnosis and treatment decisions of esophageal leiomyomas.Objects:The purpose of this paper is to describe the form of clinical resentation, epidemiological data, presenting symptoms, diagnostic investigations, tumor location, follow-up findings, and safety and efficacy of EUS and endoscopic resection, and to investigate the clinical value of endoscopic ultrasonography (EUS) for the diagnosis and treatment of esophageal leiomyoma in elder patients.Methods:From June 2005 to June 2015, a total of 2134 patients with primary diagnosis of esophageal leiomyoma by EUS in the First Attached Hospital of Zhejiang University, China, were enrolled. There are 249 cases of elder patients (> 65 year old) and 1885 of non-elder patients (< 65 year old). The clinical characteristics of the patients were analyzed, and those who had therapeutic indications received endoscopic resection or surgical excision. Asymptomatic patients and those who received endoscopic resection or surgical excision were monitored and followed up by endoscopy. Statistical analyses were performed using SPSS 17.0 software for Windows (SPSS, Chicago, USA). P< 0.05 (two-tailed test) was considered statistically significant.Results:1. In elder patients, EUS examinations were well tolerable, without serious complications, such as bleeding, perforation, or cardiopulmonary event. Of the 249 patients with esophageal leiomyoma,33 received endoscopic resection or surgical excision. And 16 (48.5%) elder patients accompanied with hypertension, diabetes mellitus, coronary heart disease, chronic bronchitis and COPD, which was noted more than non-elder patients group (P=0.005). Compared with non-elder patients group, the abnormal serum tumor marker was observed more than elder patients group, which had significant difference (P=0.047).2. Multiple lesions, the site of distribution, origin and tumor size of esophageal leiomyoma in elder patients show no significant difference compared to non-elder patients (P> 0.05).3. Compared with non-elder patients, fewer elder patients choose endoscopic or surgical therapy (P<0.001), while the incidence of complications was significantly higher, especially postoperative infection(P= 0.039). Inpatients of elder patients have higher ratio than non-elder patients, P<0.05.4. In 27 pathological diagnosis cases of elder patients, the consistency of preoperative EUS diagnosis and pathologic diagnosis is 81.8%(27/33). There is a higher proportion of cancer misdiagnosis in elderly group, about 33.3%, significantly higher than the non-elder group (6.1%, P= 0.021).Conclusion:1. Elder patients having esophageal leiomyoma accounted for 11.7% in all cases, the site of distribution, origin, tumor size and other characteristics of EUS imaging have no significant difference compared with non-elder patients.2. Elder patients accompanied with hypertension, diabetes mellitus, coronary heart disease, chronic bronchitis, COPD and other lung diseases were significantly higher. Serologic abnormalities such as tumor markers are more common, and the condition is more complex.3. Preoperative diagnostic accuracy of EUS for esophageal leiomyoma in elder patients is 81.8%, which is the best diagnosis method. Elder patients have good tolerance for EUS examination, even accompanied with more underlying diseases, EUS examination can be processed successfully.4. EUS can help make treatment decisions of elder patients with esophageal leiomyoma. Indications for treatment should be considered according to the lesion site, surgery will, tumor size, etc. Surgical complications are more common in elder patients, particularly increased incidence of infection, so we should strengthen postoperative monitoring.