The Pathological Characteristics And Curative Effect Of Upper Gastrointestinal Submucosal Tumors With Endoscopic Resection

Objective: This study is designed to investigate the pathology characteristics of different types of the upper gastrointestinal submucosal tumor,to deepen the understanding of submucosal tumors,to evaluate the clinical curative effect and safety of endoscopic excision of SMTs,to guide the treatment of SMTs,and to provide a better method of treatments.Methods: Clinical data of 70 cases who were diagnosed with the upper gastrointestinal submucosal tumor and treated by endoscopic resection in the Second Hospital of Dalian Medical University during December 2014 to December 2016,were retrospectively analyzed.All the samples were taken pathology examinations after removing the tumor,and if necessary,an immunohistochemical examination and molecular biology or the related pathology detection was employed.All patients were required to have a postoperative endoscopic follow-up on a regular basis.By collecting gastroscopic report,ultrasonic gastroscopy report,treatment report by endoscopic,pathological result report and postoperative course for the 70 cases,we get the data of lesions,treatment process and the diagnosis result,to observe patients' intraoperative and postoperative complications,operation time,length of hospital stay,pathological findings,result of the endoscopic review observing wound healing situation and lesions with or without recurrence or residual to evaluate the therapeutic effect of endoscopic resection,and to summarize the pathological characteristics of different types of SMTs.Results: In the 70 cases,there are 22 men,48 women,average aged between(56.49 ± 10.12).19 cases' lesions are located in esophagus,47 cases in stomach and 4cases in duodenum.We chose different endoscopic operation based on the characteristics of focal origins.11 cases had a resection of endoscopic trap,38 cases were treated by the ESD therapy,8 cases by the ESE therapy,9 cases by the EFR therapy,4 cases by the STER therapy.The lesions changed between 0.3 to 3.5 cm,the average is(0.95±0.65)cm.The surgery time is between 10 to 210 min,the average is(64±47)min.Pathology results: 25 cases tend to slide fibroids(35.71%),22 cases tend to stromal tumor(31.43%),6 cases are inflammation(8.57%),4 cases are lipoma(5.71%),3 cases are cyst(4.29%),2 cases are schwannoma(2.86%),2 cases are muscle fiber mother cell tumor(2.86%),2 cases are duodenal gland adenoma(2.86%),1case is hemangioma(1.43%),1 case is ectopic pancreas(1.43%),1 case is granular cell tumor(1.43%),1 case is the mass outside gastric cavity(1.43%).Immunohistochemical detection results : SMA,CD34,CD117,DOG-1,S-100's positive expression rate in leiomyoma is 100%,36.84%,22.11%,36.84%,15.79%.KI-67 index < 1%,1% and > 1% of the proportion is 11.11%,27.78% and 61.11%.SMA,CD34,CD117,DOG-1,S-100 positive expression rate in stromal tumor is 55.56%,83.33%,100%,100%,0.KI-67 index < 1%,1% and > 1% of the proportion of 42.11%,47.37% and 10.53%.In 70 cases of patients,the number of cases of Ki?67 > 10% is 0.18 cases are diagnosed as gastric stromal tumor combined pathology to immunohistochemical examination.In the 18 cases,the dangerous degree of 17 cases are extremely low invasion of risk,1 case is low risk.24 cases had intraoperative bleeding.The bleeding rate was 34.29%.Excluding artificial perforation caused by EFR,there was not accidental intraoperative perforation.49 cases had no postoperative complications.7 cases were unwell after pharyngeal or sternal.8 cases had pain under the xiphoid process or abdominal pain.2 cases had fever.1 case had pneumonia caused by suction mistakenly with general anesthesia.1 case had postoperative esophageal fistula.There was no delayed bleeding.The average length of hospital stay postoperatively is about(4.72±0.41)days.All 70 patients' postoperative wound healed well.The follow-up patients had no postoperative complications.And so far nobodyappeared residual disease and relapse.Conclusion: Different type of upper gastrointestinal submucosal tumor has its own pathology characteristics.According to the morphological characteristics of tumor and immunohistochemical examination,we can determine the type of the tumor.Endoscopic resection of upper gastrointestinal submucosal tumor is safe and effective,which can achieve the complete resection of tumor,have an accurate judgment of the type of SMT,and guide the next step treatment.Accompanied by endoscopic minimally invasive technology mature and promotion,complications of endoscopic treatment will be less and less.It has become the first and the main treatment of SMTs.