Clinical Study Of The Diagnosis Value And Endoscopic Treatment Of Upper Gastrointestinal Submucosal Lesions By Endoscopic Ultrasonography

Objective To discuss the diagnosis features and value of upper gastrointestinal submucosal lesions by endoscopic ultrasonography,compare the accuracy rate of EUS with gastroscope on the basis of pathological diagnosis and choose therapeutic effect of the endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD)through characteristics of EUS examination,w hich provides basis for clinical diagnosis and treatment.Methods From December 2014 to January 2016,to select patients with common gastroscopic examinations and definitive diagnosis of submucosal lesions,who have made EUS examination in the Second Hospital of Dalian Medical University,or made EUS-FNA?EMR?ESD and other endoscopic treatment in our hospital.By comparing the endoscopic diagnosis,EUS diagnosis with final pathologic diagnosis,to analyze upper gastrointestinal submucosal lesions and the difference of their accuracy rate.And accord ing to the origin,size,boundary,evenness,hypoechoic foci,etc,of the echo,to choose EMR ESD and record intraoperative and postoperative complications.Result 1.Diagonosis result of upper gastrointestinal submucosal lesions(EUS):(1)O f 125 cases of submucosal lesions,there are 53 cases in esophagus,56 cases in stomach and 16 cases in duodenum.Most upper gastrointestinal submucosal lesions happen in esophagus and stomach,and a few in duodenum.1)Esophagus lesions happen mostly in middle and lower esophagus,they seldom happen in upper esophagus.2)Most stomach submucosal lesions happen in fundus of stomach,body of stomach and gastric antrum,and a few in cardiac part.(2)Area and type analysis of upper gastrointestinal submucosal lesions: 1)Most esophagus submucosal lesions happen in leiomyoma.Most leiomyoma happen in middle and lower esophagus.2)O f stomach submucosal lesions,gastrointestinal stromal tumor are mostly found.Most gastrointestinal stromal tumor happen in fundus and body of stomach.Most ectopic pancreas happen in gastric antrum.(3)EUS characteristics of upper gastrointestinal submucosal lesions: 1)Leiomyoma: mostly happen in esophagus;EUS characteristic: 23 cases originate from muscularis mucosa,29 cases originate from muscularis propria,presenting hypoecho,50 cases with homogeneous echo,2 cases with heterogeneous echo.2)Gastrointestinal stromal tumor: mostly happen in stomach.EUS characteristic: 34 cases of gastrointestinal stromal tumor originate from muscularis propria,presenting hypoecho,24 cases with homogeneous echo,10 cases with heterogeneous echo.3)Ectopic pancreas: mostly happen in stomach.EUS characteristic: 10 cases originate from submucosa,4 cases origniate from muscularis propria,3 cases origniate from of submucosa and muscularis propria,which 8 cases present medium high echo,8 cases present equal echo,1 case presents hypoecho,of which 2 cases with homogeneous echo,15 cases with heterogeneous echo.4)Lipomas: EUS characteristic: 9 cases of lipomas originate from submucosa,presenting Hyperechoic,of which 7 cases with homogeneous echo,2 cases with heterogeneous echo.5)Cysts: EUS charcteristic: 12 cases originate from submucosa,presenting anechoic.6)Adenoma: 1 case,originates from duodenum;EUS characteristic: originating from submucosa,presenting mixed echogenicity.2.Lesion diagnosis accuracy rate of upper gastrointestinal submucosal lesions by EUS and gastroscope: EUS diagnosis are total accuracy rate is 81.5%;gastroscope diagnosis are total accuracy rate is 41.1%.Through qualified EUS diagnosis and gastroscope diagnosis,there exists significant statistic difference(P <0.01).For upper gastrointestinal submucosal lesions,EUS diagnosis is superior to gastroscope diagnosis.3.Endoscopic treatment of upper gastrointestinal submucosal lesions: through informing the patients of preoperative advantages and risks of all treatment methods,combining their lesion characteristics,willingness of the patient and his family,54 patients finally opera ted EMR and ESD treatment,including 19 cases of EMR and 35 cases of ESD treatment.Of which sudden bleeding happened in ESD operation in 1 case of muscularis propria lesion,and has been transerred to surgery;the muscularis propria appeared after perforation of ESD operation of 1 case of muscularis propria lesion,which has been stopped with hemoclip.Conclusion 1.EUS can provide the origin,size,boundary,homogeneity and existence of focus of echo,etc.For upper gastrointestinal submucosal lesions,EUS has higher diagnosis value and is superior to gastroscopic diagnosis.2.Submucosal lesions of esophagus mostly happen in leiomyoma,often in middle and lower esophagus;submucosal lesions of stomach mostly happen in gastrointestinal stromal tumor,often in fundus and body of stomach.3.After EUS examination of upper gastrointestinal submucosal lesions,choosing EMR and ESD according to lesion charateristics is safe and effective.