| Background and aim:Gastrointestinal lipomas(GIL)are subepithelial lesions that can be found in the whole digestive tract.Commonly,they are benign,single,slowly growing and composed of well-differentiated adipose tissue covered by a fibrous capsule.The disease is relatively rare,and the overall incidence of the population is about 0.035%-4.4%.The diagnosis mainly depends on radiological,endoscopic means as its clinical manifestations and laboratory tests are always non-special for an early diagnosis.Compared with ordinary endoscopy,endoscopic ultrasound(EUS)is an important method for the diagnosis of GIL which could clearly provide the lesion information about original layer,size,shape and echogenicity,but there are no literature reports on the systematic evaluation of EUS for the diagnosis of GIL.The asymptomatic GIL can be observed,but the symptomatic or large mass needs treatment.Endoscopic or surgical resection is the main choice.However,due to the GIL is extremely rare,there is lacking systematic retrospective analysis of GIL clinical features and no consensus on the diagnosis and treatment.Therefore,the purpose of this study is to retrospective analysis the GIL patients in the First Affiliated Hospital of Zhejiang University from2007 to 2017,summarize the experience in diagnosis and treatment of GIL,analyze the clinical characteristics of GIL,explore the diagnostic value of EUS in GIL,and provide a reference for the reasonable diagnosis and treatment of GIL.Methods:We collected gastrointestinal lipoma patients diagnosed by endoscopy,EUS,CT or pathologically in the First Affiliated Hospital of Zhejiang University.Basic data,clinical symptom,serological examination,lesion characteristics,endoscopic and EUS performances,CT imaging manifestations,diagnosis and treatment,and follow-up outcomes would be retrospective analysis.Data analysis was performed using Stata SE15.Result:1.A total of 198 pathologically confirmed patients were included,including 112 female patients and 86 male patients,with female to male ratio of 1.3.Patients were aged between 25-91 years,with an average age of 59.1 ±12.4 years.One patient was an esophagus with gastric antrum lipoma,so a total of 200 lipoma lesions were observed,and the number of upper,middle,and lower GIL lesions were 69(34.7%),36(18.1%),and 94(47.2%).A total of180(90.5%)lesions had size information.The average long diameter was 2.4± 1.6cm,the average short diameter was 1.8 ± 1.1cm,and the number of lesions with a long diameter exceeding 2cm was 83.2.There were differences clinical characteristics in lipoma patients in different parts of the digestive tract.Patients with upper gastrointestinal lipoma(UGIL)were mainly complained with non-specific digestive symptoms;patients with middle gastrointestinal lipoma(MGIL)were always diagnosed with secondary intussusception or intestinal obstruction;the chief complain for patients with lower gastrointestinal lipoma(LGIL)could be roughly divided into non-specific digestive symptoms,abnormal bowel movements or gastrointestinal bleeding,and some would progress to intussusception or obstruction.The average age of patients with MGIL was 65.4 ± 14.6 years, which was significantly larger than that of UGIL(55.1 ± 1.0 years,P<0.001);the average long diameter of MGIL was 3.5 ± 1.4cm,which is significantly larger than UGIL and LGIL(2.0 ± 1.2cm,2.7 ± 1.9cm,P <0.001);the average short diameter of MGIL was 2.4±0.9cm,which is significantly larger than UGIL(1.6 ± 0.9cm,P <0.001);the hemoglobin content in the MGIL is significantly lower than that in UGIL and LGIL.Correspondingly,the incidence of anemia,OB(+),the inpatient days and hospitalization cost all significantly increased in MGIL(P <0.001).3.151 patients had complete clinical data.Further analysis revealed that the first three abnormal rate of the laboratory indicators of GIL was OB positive rate(32.2%),hypertriglyceridemia(24.6%),and anemia(21.2%).In addition,GIL patient had a 42.1% incidence of fatty liver.4.EUS showed that lipomas usually appear as round or ellipse hyperechoic masses(88.2%)in the submucosa(95.6%),with uniform echo(88.2%)and clear borders(100%);The average long diameter of section was 1.3 ± 0.6cm and short diameter was 0.8 ± 0.5cm.There were 8 cases of lipoma with nonhyperechoic,6 of which were misdiagnosed in EUS,with a misdiagnosis rate of 75%;The coincidence rate of EUS in the diagnosis of lipomas was 87.1%,which was higher than that of CT examinations by 57%(P <0.001);Further analysis found that long diameter of mass is an important influencing factor for CT diagnosis,with an odds ratio of 2.0,a 95% confidence interval of 1.1-3.6,and P = 0.026.5.There were differences in treatment options for lipomas in different parts of the digestive tract.96.7% of UGIL patients received endoscopic treatment,50.0% of LGILs chose endoscopic treatment and all MGILs were treated with surgery.Both endoscopic and surgical treatments have a high success rate(98.9% vs 100%),but compared with surgical treatment,the endoscopic treatment has a significant improvement in the indicators of intraoperative bleeding volume(1.8 ± 4.9ml vs 56.6 ± 35.9ml),operation time(44.9 ±33.4min vs 113.5 ± 52.1min),fasting time(2.4 ± 1.9d VS 7.1 ± 3.0d),hospital stay(9.2 ± 4.0d vs 15.9 ± 7.2d),hospitalization costs(14880.2 ± 7329.2 ￥ vs34893.0 ± 17465.2 ￥)and postoperative temperature(37.5 ± 0.5 ℃ vs 38.0 ±0.5 ℃),(P <0.001).Those indicators were still statistically significant when excluding 26 MGIL cases.Furthermore,the amount of antibiotics used in endoscopic treatment was less than surgical treatment(P<0.001).6.About nylon ligation,the average intraoperative bleeding volume was0.3 ± 0.1ml,the operation time was 12.3 ± 11.6min,the fasting time was 0.9 ±0.6d,the hospitalization time was 6.2 ± 2.3d,and the postoperative temperature was 37.1 ± 0.3 ℃ and the hospitalization cost were 5812.5 ±3311.0 yuan.The six indicators were the lowest in endoscopic treatment,but the technical failure rate of this treatment was 8.1%,and pathological verification was usually difficult to obtain.7.Long-term follow-up showed that patients usually has a good prognosis;1 patient under endoscopy treatment showed a 0.4 * 0.4cm ulcer with active inflammation at the surgical site on 148 days;1 case under surgical treatment was found recurrence and another1 case found sinus tract formed;1 case under nylon ligation treatment found lipoma remained;49 untreated lipoma patients participated in EUS follow-up,and the average follow-up interval was 666±550.5 days.The average increase value of the long diameter was 0.03 ±0.38 cm and short diameter was 0.02 ± 0.23 cm.,there was no statistical difference in the diameter change.Conclusion Gastrointestinal lipoma is a benign submucosal lesion of gastrointestinal tract with low incidence and slow growth.They usually present between 50 and 70 years of age and are slightly more common in females.Its clinical symptoms and laboratory are non-specific.EUS is the main diagnostic method for gastrointestinal lipoma,and its diagnostic accuracy rate is better than ordinary endoscopy and CT.The treatment of GIL is mainly about surgical or endoscopic resection which both have high success rate,good prognosis and rare recurrence.Endoscopic resection is more minimally invasive and economical than surgical resection which should be used as the first choice for gastrointestinal lipoma resection. |
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