| Objective: 1. To evaluate the importance of endoscopic ultrasonography in diagnosing subepithelial lesions of upper digestive tract. 2. To improve endoscopic ultrasound diagnosis of upper gastrointestinal submucosal lesions(GSL) by analyzing the causes of misdiagnosis and dissecting ultrasonic characteristics of GSI in misdiagnosis patients.Methods: Select 2232 patients from January 2000 to January 2014 at the First Affiliated Hospital of Soochow University. These patients, 1082 male 1150 female patients,aged from 14 to 87, averaged age 53, all suffer from protrusion lesions in the upper digestive tract. Among these patients 643 have pathology, 280 patients were male363 cases were female, aged from 17 to 78, averaged age 52. Retrospectively analyzing the spectrum of disease, the distribution of disease, the echo characteristics of submucosal lesions and analyse misjudgement reasons.Results: 1.Spectrum of disease:2232 cases of submucosal lesions, 688 cases were leiomyoma(30.8%), 449 cases were inflammation(20.1%), 290 cases were stromal tumor(12.9%), 204 cases were external pressure(9.1%), 194 cases were malignant tumor(8.6%), 127 cases were cysts(5.6%), 102 cases were ectopic pancreas(4.5%), 98 cases were venous aneurysms(4.3%), 41 cases were lipomyoma(1.8%), 18 cases were duodenal Brunner gland hyperplasia(0.8%), 10 cases were adenoma(0.4%), 11 cases were papilloma(0.4%). 2. Disease distribution:2232 cases of submucosal lesions,973 cases of esophageal origin, including the upper esophagus 180 cases,411 cases of middle and lower section of 382 cases;originate the stomach 1082 cases,of which 291 cases of fundus,antrum 388 cases,gastric body 243 cases,31 cases of gastric angle;177 cases originate the duodenum.3.Acoustic features:leiomyoma appeared as hypoechoic;476 cases originated in the muscularis mucosa, 202 cases of muscularis propria, 10 originate serosa layer.Stromal tumors appeared as uneven hypoechoic; 47 cases originated in the muscularismucosa, submueosa in 12 cases, 211 cases of muscularis propria, serosa in 18 cases. 137 cases of malignant tunlor are hypoechoic, 57 cases of mixed echo; originated in the muscularis mucosa in 23 cases,40 cases of the submucosa,muscularis propriain 76 cases,55 cases of serosa layer.Ectopic pancreas are hypoechoic in 62 cases,40 cases of mixed echo;23 cases originated in the muscularis mucosa, submucosa in 79 cases.Inflammation is equal echo in 173 cases; 75 cases of hypoechoic,201 cases of hyperechoic;originated in the muscosa in 275 cases, the muscularis mucosa in 102; the submucosa in 72 cases.Lipomas are equal echo in 8 cases,high echo 33;originated in the muscularis mucosa in 10 cases,26 Cases of the submucosa, muscularis propria in 5. Cysts are no echo in 106 cases, hypoechoic in 8 cases, 13 cases of mix echo; 79 cases originated in the submucosal, mucosa in 48 cases. 71 cases of venous aneurysmg arc no echo,hypoechoic in25 cases, hyperechoic in 2 cases;originated in the mucosa in 74 cases, the submucosa in 24 cases.36 cases of external pressure are no echo,hypoechoic in 88 cases, hyperechioc in 80 cases. Among these 36 cases, 6 cases are trachea, 15 are aortic arch, 3 cases are mediastinal tumors,74 cases are spleens,gallbladder in 40,pancreatic cysts in 3 cases. 4.Endoscopic ultrasound and pathology coincidence rate:we do the biopsy in 643 patients,590 cases’ ultrasound diagnosis are consistent with the pathologic diagnosis, the coincidence rate is 91.7%. The highest diagnostic accuracy is inflammatory hyperplasia,100%, followed by malignant tumor is 97.1%. Lipomas and leiomyoma diagnostic accuracy are 91.6% and 90.5%,stromal tumors is 74.5% and ectopic pancreas is 72.2%.Conclusion: 1. Endoscopic ultrasound is quite a valuable means for the diagnosis of upper gastrointestinal subepithelial lesions. The common lesions are leiomyoma,inflammatory hyperplasia, stromal tumor and external oppressure. 2. Upper gastrointestinal submucosal lesions more commonly occur in the stomach. Gastric stromal tumors is more common than other lensions. Middle Esophageal lesions are more common than upper and lower esophageal. External oppressure is common and mostly occur in aortic arch. Most lesions lie in the muscularis propria, followed by mucosal muscularis, submucosa, mucosa and outer membrane. 3. It is difficult to identify leiomyoma, stromal tumor and ectopic pancreas; Leiomyoma tends to occur in the esophagus, and stromal tumor develops in the stomach. Under the ultrasound the tumors with uniform echo and originated in thesubmucosal to the muscularis propria are more likely to be stromal tumor other than leiomyoma. Lesions located in the gastric antrum, especially in the greater curvature,originated in the submucosal layer of the gastric apophysis lesions, with mixed echo,unclear boundary and irregular shape, tend to be considered as the gastric ectopic pancreas.4. Malignant tumors under endoscopic ultrasonography ultrasonographic performance for low echo conglomeration shadow more, echogenicity, uneven, each layer structure disorder identify more easily disappear, but the invasion depth of judgment accuracy is not high. If the lesions lie in the gastric antrum or stomach angle, judgment will be less accurate, but20 MHz probe has higher distinguishability. |
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