Research Of Endoscopic Ultrsonography In The Diagnosis And Treatment Of The Upper Gastrointestinal Submucosal Lesions

Objective1. To discuss the valuable of endoscopic ultrasonography in diagnosing upper gastrointestinal submucosal lesions; To evaluate the accuracy of EUS in diagnosing upper gastrointestinal submucosal lesions by using histology as the criterion standard.2. To discuss the application value of the EMR and ESD guided by EUS in the treatment of the upper gastrointestinal submucosal lesions.Methods1. The first part:We chose the patients who had received the EUS and diagnosed as upper gastrointestinal submucosal lesions, and had accepted the endoscopic treatment or surgery in Qilu Hospital of Shandong University from February2009to February2012.154cases with158lesions, which were composed of73males and81females were selected into our study. All of them had obtained the pathologic diagnosis. The mean age of this patients was50.6years. To compare the diagnosis of EUS and pathology for the upper gastrointestinal submucosal lesions,analysis the accuracy of EUS.2. The second part:We chose the patients who had received the EUS and diagnosed as upper gastrointestinal submucosal lesions,and then received the EMR or ESD treatment according to the results of EUS in Qilu Hospital of Shandong University from February2009to February2012. Totally there were61cases composed of33 males and28females, and the average age was48.9years. All of the patients were followed up by the regular endoscopy.Results1. The accuracy of Endoscopic ultrasonography and pathological diagnosis:Using histopathology as the gold standard, the overall diagnostic accuracy of EUS imaging was69%(100out of158). The accuracy of EUS imaging for the diagnosis of esophageal, gastric, and duodenal submucosal lesions was78.3%(18/23),69.8%(88/126) and44.4%(4/9) respectively. The accuracy of EUS imaging for the diagnosis of esophageal, gastric, and duodenal submucosal lesions in the group of less than2cm was73.3%(11/15),61%(47/77),37.5%(3/8) respectively. The accuracy of EUS imaging for the diagnosis of GIST, leiomyoma, heterotopic pancreas, lipoma was94.4%(68/72),57.5%(23/40),40.0%(8/20),81.8%(9/11) respectively.2. The mean size of the158lesions measured by EUS was2.1±1.7cm (range,0.4-12.5cm). Analysis the length diameters of the correct group (n=110cases,2.3±1.8cm)and the incorrect group (n=48cases,1.5±1.3cm,), P=0.011<0.05.3. The accuracy of the greater than2cm group (n=58cases) and less than2cm group(n=100cases) was84.5%(49/58) and61%(61/100)respectively, a chi-square test P=0.002<0.05.There was significant difference between the two groups. We compared the layers of origin between the two groups, P=0.003<0.05.4.61cases of upper gastrointestinal submucosal lesions was included,40cases accepted the ESD while the rest (21cases) of the patients received the EMR.The mean size measured by EUS of the lesions was0.89±0.32cm(range0.3～2.5cm). Except two patients whose lesions were located in the muscularis propria and treated by ESD occurred bleeding and turned to surgery, the rest of the cases were successful resection. All of them were followed-up for1～36months, and without recurrence and metastasis.Conclusion1. Endoscopic ultrasonography can judge the origin,size,location,and the echographic features of the upper gastrointestinal submucosal lesions, but it is difficult to make the exact qualitative diagnosis of the lesions.The accuracy of the EUS needs to improve. For the suspicious lesions diagnosed by EUS,it is necessary to obtain the histological diagnosis by using the EUS-FNA,EUS-TCB et al. For the small submucosal lesions, endoscopic resection such as ESD or EMR should be taken to obtain the histopathologic diagnosis.2. ESD or EMR is the safe and effective treatment method for the submucosal lesions of upper gastrointestinal tract under the guidance of the endoscopic ultrasonography.They also can obtain the histopathologic diagnosis.