The Evaluation Of Endoscopic Ultrasonography In Protuberances In Upper Gastrointestinal Tract

Objective: To evaluate the value of endoscopic ultrasonography in the diagnosis and treatment of protuberances in upper gastrointestinal tract.Methods: Retrospective analyzed the results of 823 protuberances in upper gastrointestinal tract performed endoscopic ultrasonography from 2007 to 2014 in a single center.Results: 1. A total 823 protuberances found in 793 patients were included, with 514 cases were male, aged 22-74 years old; 279 cases were female, aged 28-77 years old,277 leisions were diagnosed pathologically,102 cases in esophagus, 175 cases in stomach and duodenum.There were 82 cases of external pressure and 39 cases of submucosal cyst and hemangioma were confirmed by CT, MRI and follow-up.so we confirmed 398 protuberances in upper gastrointestinal tract A totally. 2.There were 225 protuberances located in the esophagus, which were found in 217 patients include 134 male and 83 female,102 protuberances confirmed pathologically. 22 cases of external pressure and 19 cases of vascular tumors,cysts were diagnosed by CT and follow-up. Respectively, there were 45,123,3,12 cases located in superficial mucosa, muscularis mucosa, submucosa and muscularis propria. 21,94,110 cases distributed respectively in the upper, middle and lower sections.The diagnostic accuracy rate EUS was significantly higher than normal endoscopy. 3.There were 598 protuberances located in stomach and duodenum, which were found in 576 patients include 380 male and 196 female.175 protuberances confirmed pathologically. 60 cases of external pressure and 20 cases of vascular tumors,cysts were diagnosed by CT and follow-up. Compared with the sensitivity, specificity, positive predictive value, negative predictive value in external pressure, smooth muscle tumors, polyps, stromal tumors, cancer, ectopic pancreas, external pressure was highest,which was greater than 90%. Compared with 42 cases of stromal tumors and 51 cases of leiomyoma,there was a significant difference(p <0.05) in age, size,internal echo,calcification. Compared with 11 cases of benign stromal tumors and malignant stromal tumors,there was a significant difference(p <0.05) in size, edge, internal echo, internal cystic degeneration and calcification. 4.There were 398 protuberances in upper gastrointestinal tract confirmed,include 85 cases of external pressure, 3 cases(3.53%) treated by surgery or laparoscopic surgery, 1 case(1.18%) treated by medical, 81 cases(95.29%) follow-up.There were 139 Non-external pressure lesions less than 2cm located in superficial mucosa or muscularis mucosa, 115 cases were treated by EMR(82.73%).23 cases,21 were treated by ESD(91.3%). There were 39 cases of submucosal cyst treated by puncture and ligation(97.44%),11 cases of ectopic pancreas and lipoma were treated by ESD, EMR(84.62%). There were 54 cases of leiomyoma and stromal tumor located in muscularis propria, 5 cases less than 2cm and without adverse factors followed-up. 13 cases treated by endoscopic ligation and ligation-resection,6 cases. There were 30 cases greater or equalthan 2cm include 1 case follow-up and 29 cases treated by surgery or Laparoscopic surgery. 5.There were 3 malignant lesions invasived to mucosa or submucosa, 1 case treated by EMR, 2 cases treated by ESD; 4 malignant lesions invasived to muscularis propria,3of them treated by laparoscopic surgery, 1 case treated by ESD. 27 malignant lesions invasived serosa were treated by laparoscopic surgery.Conclusion: 1.Protuberances in esophageal distributed more ofen in superficial mucosaand muscularis mucosa at middle and lower section, Esophageal leiomyoma located in the muscularis mucosa was the most common. 2. The external pressure was the most common protuberances in stomach and duodenum, EUS is essential in differential diagnosis of leiomyoma and stromal tumors, benign and malignant stromal tumor. 3. ESD, EMR, puncture, ligation, ligation resection, follow-up, laparoscopy, surgery were all proved effective way to treat protuberances in upper gastrointestinal tract,a reasonable choice should be based on each endoscopic ultrasound characteristics.