Endoscopic ultrasonography in diagnosis and therapy of submucosal tumors in upper gastrointestinal tract

• Published in: Endoscopy
• Main Authors: Xu, Xin, Wang, Bangmao, Chang, Yixiang, Yu, Qingxiang, Liu, Wentian
• Format: Conference Proceeding
• Language: English
• Published: 02.12.2011
• ISSN: 0013-726X; 1438-8812
• DOI: 10.1055/s-0031-1292230

Background: The tool of first choice for examining SMTs in the upper GI tract is endoscopic ultrasonography (EUS). It is the most accurate procedure for detecting and diagnosing SMTs, due to its high sensitivity and specificity. EUS combined with endoluminal resection techniques is increasingly used to provide a definitive diagnosis of submucosal tumors. Aim: To evaluate the diagnostic value of Endoscopic ultrasonography (EUS) and endoscopic therapies in gastrointestinal submucosal tumors (SMT). Methods: A total of 260 patients with SMTs of upper gastrointestinal diagnosed by endoscopy were examined using EUS. Endoscopic therapy, including endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD), had been taken according to the different deriving layers, histology and size. The ultimate diagnosis was confirmed by histology. Results: Among all 260 cases, leiomyoma was the most common (101 cases), followed by cysts (46 cases), vascular lesions (32 cases), ectopic pancreases (30 cases), lipoma (25 cases), gastrointestinal stromal tumors (GIST) (19 cases), early carcinoma (5 cases) and carcinoid(2 cases). The sizes of lesions in 260 cases were 0.4 to 2.5cm in diameter. The lesions in 164 cases were resected by EMR, and 96 cases were resected by ESD. Conclusion: EUS is of considerable value in the diagnosis of gastrointestinal SMT, and is also important in selecting treatment procedures of submucosal gastrointestinal tumors. References: [1] Rösch T, Kapfer B, Will U, et al. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study. Scand J Gastroenterol. 2002;37:856–862 [2] Waxman I, Saitoh Y, Raju GS, et al. High-frequency probe EUS-assisted endoscopic mucosal resection: a therapeutic strategy for submucosal tumors of the GI tract. Gastrointest Endosc. 2002;55:44–49 [3] Muto M, Miyamoto S, Hosokawa A, et al. Endoscopic mucosal resection in the stomach using the insulated-tip needle-knife. Endoscopy 2005; 37: 178–182. [4] Oka S, Tanaka S, Kaneko I, et al: Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006; 64: 877–883. [5] Pech O, Behrens A, May A, et al: Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's esophagus. Gut 2008; 57: 1200–1206. [6] Fujishiro M, Yahagi N, Kakushima N, et al: Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 2006; 4: 688–694. [7] Ribeiro-Mourão F, Pimentel-Nunes P, Dinis-Ribeiro M. Endoscopic submucosal dissection for gastric lesions: results of an European inquiry. [8] Kim BJ, Chang TH, Kim JJ Efficacy and safety of endoscopic submucosal dissection for early gastric cancer in patients with comorbid diseases. Gut Liver. 2010 Jun;4(2):186–91. [9] Inaba T, Ishikawa S, Toyokawa T Basal protrusion of ulcers induced by endoscopic submucosal dissection (ESD) during treatment with proton pump inhibitors, and the suppressive effects of polaprezinc. Hepatogastroenterology. 2010 May-Jun;57(99–100):678–84.