| Background: Submucosal tumor (SMT) is a large number of diseases consist of thebenign, malignant and potentially malignant lesions. The incidence of SMT is low(approximately0.36%).There is no obvious clinical symptom and it usually can befound incidentally only when doing the endoscopic examination. Currently, thetreatments of SMT include surgeries, endoscopic excisions, and regular follow-upobservations. What treatment to be adopted mainly depends on the whether the lesionsare benign or malignant. However, for the lesions below the mucosal layer, theconventional mucosa biopsy often cannot obtain the desired pathological results. It isthe biopsy guided by endoscopic which makes the gold standard of diagnosis, but this islikely to cause the tumors to spread for the malignant lesions. Then, can we distinguishthe benignancy and malignancy lesions of SMT according to their different features toguide the clinical therapy? Many academic literatures believe that the SMT withdiameter>3cm has a risk of malignant transformation and should be removed.However, for the patients with the SMT≤3cm in diameter, can we adopt thenon-surgical follow-up strategy? If it is possible, how to develop the follow-up strategy?This experiment will expound it.Objective: Observe the nature history of gastrointestinal submucosal tumor(SMT) andthe common characters of the malignant SMTs.，to access the malignant potential of theSMTs tumor size≤3cm.Method: to carry on retrospective analysis research to the844sufferers withendoscopically diagnosed SMT at our hospital from April2005to September2012(excluding sufferers with firstly endoscopically diagnosed SMT but SMT disappearedin follow up or non-SMT patients confirmed by EUS，GI or CT.Results:1, During endoscopic follow up with89sufferers from0-31years,10sufferers had sign of malignant transformation and operation was performed, these malignant caseswere confirmed by pathology but did not have systemic metastasis;9sufferers hadSMT with diameter≤3cm and did not have recurrence in0-5years follow up afteroperation.2, Group SMT patients with diameter≤3cm according to SMT’s size: group withdiameter≤1cm, group with1cm<diameter2≤cm, group with2cm <diameter≤3cm, the bad risk for three groups were1.6%（1/63），16.7%（3/16），66.7%（4/6），P<0.05，this was statistically significant.3,15of844sufferers were diagnosed with2SMT at different parts, so there were859SMTs in total.263SMT were in esophageal, accounting for30.6%;420SMTwere in Stomach, accounting for48.9%;42SMT were in small intestinal,accounting for4.9%;134SMT were at Colorectal, accounting for15.6%. MalignantSMT, with a total of50, were located in different part of digest tract. Incidences ofmalignant SMT in esophageal， Stomach, small intestinal， Colorectal were0，17.1%(72/420)，7.1%(3/42) and8.2%（11/134）separately, P<0.05.4,356patients were under EUS investigation.50with malignant SMT manifested aswith inhomogeneous echopattern, cystic spaces, exophytic and border irregularity; theremainings were with bengin SMT and most of them manifested as withhomogeneous echopattern, endophytic and margin regularity.Conclusion:1, For patients whose diameter of SMT were no bigger than3cm（especiallydiameter≤1cm） and without obvious maglinant performanceunder endoscopic orEUS, we can make an appropriate surveillance interval based on the size of tumorduring a long follow-up period.2, The canceration risk of SMT is related to the tumor size: The smaller the diameteris, the lower risk of malignant transformation there is;3, The distribution of SMT in gastrointestinal tract is totally different. SMT instomach is more common than other parts, followed by esophagus. Malignant SMTwere mostly located in stomach.4，Inhomogeneous echopattern are all closely connected with malignant lesion. Surgical resection should be considered if above symptoms happened. |
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