Value Of EUS In The Diagnosis And Treatment Of Upper Gastrointestinal Tract Bulgy Lesion

Upper gastrointestinal tract bulgy lesion are usually asymptomatic and observed incidentally during endoscopic examination, but because the endoscopic is smooth, the color is similar with the surrounding mucosa lesions, common gastroscopy cannot determine tumor’s origin, size and nature. But with the emergence and development of endoscopic ultrasound, according to the site of origin, mass and homogeneous echo intensity can be clearly the extent of the lesion, depth of invasion, relationship with adjacent organs, and determine the initial mass properties, provide the basis for the further clinical treatment.In order to explore the effects of endoscopic ultrasonography (EUS) of upper gastrointestinal tract bulgy lesion in the diagnosis and application value of ultrasound guided endoscopic interventional treatment and surgical operation, and improve the level of diagnosis and treatment of upper gastrointestinal tract bulgy lesion.Clinical data of 120 cases with endoscopic ultrasound of upper gastrointestinal tract bulgy lesion between July 1,2014 to October 31,2015 in outpatient and inpatient of our hospital, By retrospective analysis of cases of sex, age, clinical symptoms, location, origin, size, ultrasonic diagnosis, histopathological and immuno-histochemical, treatment and complications, study on endoscopic ultrasonography of upper gastrointestinal tract bulgy lesion diagnosis and treatment of clinical value.General Information 120 cases of upper gastrointestinal tract bulgy lesion,50 males and 70 females, aged 29-80 years old, average age 55 years old. Among them, there are 49 cases of esophageal lesions,63 cases of gastric lesions, and 8 cases of duodenal lesions.Clinical Manifestations all the cases were collected. The most common clinical manifestations for abdominal discomfort (abdominal pain, abdominal distension) were about 41.67%; secondly for other, such as dizziness, hoarseness, loss of appetite, physical examination and other accounteds for about 26.66%; acid regurgitation, heartburn and other gastrointestinal symptoms accounted for about 20%; dysphagia, nausea, vomiting and other gastrointestinal symptoms accounted for about 4.17%; and digestive tract bleeding symptoms such as blood in the stool, hematemesis accounted for 3.33%.The examination results of endoscopic ultrasonography (EUS) Esophageal submucosal tumor in 49 cases, including 34 cases of leiomyoma, mucosal inflammation in 8 cases,3 cases of cyst,1 case of lipoma,2 case of hemangioma, and 2 case of stromal tumor; Gastric submucosal lesions (including cardiac) of 63 cases of mucous membrane inflammation changes in 11 cases,19 cases of gastrointestinal stromal tumor, lipoma 8 cases,6 cases of leiomyoma, polyps in 4 cases, Ectopic pancreas in 6 cases, outside the wall pressure change in 3, neuroendocrine tumor in 2 cases,1 schwannoma; 8 cases of duodenal submucosal tumor, including mucosal inflammation in 2 cases, cyst 2 cases,1 case of lipoma,3 case of gastrointestinal stromal tumor.The characteristics of endoscopic ultrasonography (EUS) Leiomyoma and gastrointestinal stromal tumors originating from the muscularis mucosa and muscularis propria, homogeneous low echo changes and uneven hypoechoic changes are clear boundary, complete capsule; Mucosal inflammation and polyps originated in the mucosal layer, homogeneous or inhomogeneous high echo, clear boundary, complete capsule; Originatedin the submucosal lipoma, homogeneously or owing uniform high echo change, visible behind the sound attenuation, clear boundary, complete capsule; Originated in the submucosal cyst, homogeneously low echo or no change of the echo, clear boundary, membrane integrity; Hemangioma, originating in the submucosal mixed echo or low echo change, no echo can be seen in the structure, the boundary is clear, membrane integrity; Ectopic origin of the pancreas in the lower mucosa, the high mixed echo, clear boundary, no capsule; Gastric neuroendocrine tumor originated from submucosa, homogeneous or inhomogeneous high echo, clear boundary; Gastrointestinal schwannoma originated from the muscularis propria, homogeneous low echo, low echo edge; External pressure change visible gastric fundus disease in each layer of the hierarchy is clear, complete and continuous wall, no abnormal echo changes, hypoechoic structure out the wall is visible.The results of pathological examination 120 cases of EUS in 107 cases of surgical resection, the 99 cases of endoscopic tumor resection,6 underwent surgical resection, by pathological confirmed that incision and drainage in the treatment of confirmed 1 case of cyst wall and 1 case underwent ESD peel tumor found confirmed vessel. Of which 89 cases of pathological results and preoperative endoscopic ultrasonography (EUS) results,18 cases with endoscopic ultrasonography (EUS) inconsistent results. Gastrointestinal stromal tumor, hemangioma, cyst and ectopic pancreas were all originated from the submucosal layer, which showed low echo or heterogeneous echo, and the diagnosis rate was relatively low.(One case is more special, EUS submucosa without echo change, circular scanning ultrasonic probe tip mass no blood flow signal and diagnosis for cyst, postoperative pathology of serous cystadenoma.) Among the 120 samples collected,10 patients underwent surgical resection dueto various reasons, and 3 cases were confirmed by endoscopic ultrasonography.107 in 51 cases of EMR,33 cases of esophageal,14 cases of stomach, duodenum in 4 cases; ESD surgery was performed in 31 patients,6 cases of esophageal, stomach in 23 cases,2 cases of duodenum; ster surgery was performed in 10 patients,9 cases of esophageal, finally,1 case in the cardiac region; 9 cases underwent ESE,8 cases of stomach, duodenum in 1 case; surgery in 6 cases, are located in the stomach. Complication Endoscopic submucosal tumors may appear tract hemorrhage andperforation of digestive treatment, in the treatment of 102 cases of endoscopic in 1 case because tumor blood flows around the rich cause bleeding,2 cases with tumor in deep muscle layer stripping after perforation, having been in the endoscopic treatment, and postoperative recovery was good.The upper gastrointestinal tract bulgy lesion no significant gender differences can occur in all ages, on the clinical manifestations showed no obvious specificity;It is endoscopic ultrasonography in diagnosis of upper gastrointestinal tract bulgy lesion of the preferred method;Pathological diagnosis is still the gold standard for the diagnosis of upper gastrointestinal tract bulgy lesion;The endoscopic treatment of upper gastrointestinal tract bulgy lesion is a safe and effective method for the treatment of small injury.