Diagnostic Value Of Endoscopic Ultrasonography For Protruded

Objective:To have knowledge of the common sites, properties and sources of various protruded lesions of esophagus through a retrospective analysis of the clinical data of protruded lesions of esophagus diagnosed by endoscopic ultrasonography in the First Hospital Affiliated to Medical College of Shihezi University from June 2008 to March 2014, to analyze its coincidence rate based on histopathologic diagonosis, and to further discuss the diagnostic value of endoscopic ultrasonography for protruded lesions of esophagus. Methods:426 patients with esophageal protrusion lesions, including 221 males and 205 females (male and female ratio:1.08:1; age:21-85 years old; mean age:57.2±12.5), were diagnosed by common electronic gastroscope at the digestive endoscopy center of First Hospital Affiliated to Shihezi University Medicine School from June 2008 to March 2014. These patients undergoing endoscopic ultrasonography were retrospectively analyzed. Based on infiltration layers and sizes of protruded lesions of esophagus in these patients, further guidance was provided on how to perform minimally invasive therapy or surgical treatment under endoscopy. The overall coincidence rate was analyzed based on the results of histopathological diagnosis obtained by minimally invasive surgical treatment or surgical operation. An ultrasound endoscope (UM2000, Olympus, Tokyo, Japan) and/or ultrasonic probes (UM-DP12-25R and UM-DP20-25R) were employed to conduct endoscopic ultrasonography, with ultrasonic frequencies of 5.0MHz,12.0MHz and 20.0MHz, depending on the size of lesion.Results:1. Distribution of disease entities:426 patients with protruded lesions of esophagus who were undiagnosed by common electronic gastroscopy underwent endoscopic ultrasonography. Among them, there were leimyoma in 215 cases, stromal tumor in 59 cases, cysts in 38 cases, cancer and precancerous lesions in 36 cases, outside compression in 42 cases, hemangioma in 7 cases, esophageal mucosal uplift in 7 cases, lipoma in 4 cases, sinus in 2 cases, papilloma in 2 cases, hematoma in 2 cases, inflammation and ulcer in 5 cases, squamous cell hyperplasia in 3 cases, polyp in 1 case, myoblast cell tumor in 2 cases, glomus tumor in 1 case, and lymphangioma in 1 case. And minimally invasive therapy or surgical treatment was performed for 65 cases with esophageal protrusion lesions under endoscopy, and the diagnoses of 61 cases (93.85%) were proved to be identical to preoperative diagnoses according to the results of final histodiagnosis.2. Echo patterns:leiomyomas revealed low level echo, with 210 cases deriving from the muscularis mucosa, 1 case from the submucosa, and 4 cases from the outer membrane. Stromal tumors showed low level echo, with 2 cases form the muscularis mucosa and 57 cases from the muscular layer. Cysts presented low level echo in 7 cases, high level echo in 6 cases, and no echo in 25 cases, with 4 cases coming from the mucous layer and 34 cases from the submucosa. Precancerous and cancerous lesions showed low level echo in 32 cases and high level echo in 5 cases, with 20 cases deriving from the mucous layer,2 cases from the submuscosa,11 cases from the muscular layer and 3 cases from the outer membrane. Hemangiomas revealed high level echo in 2 cases, and no echo in 5 cases, with 4 cases from the mucous layer and the rest from the submucosa. Duplicature folds revealed high level echo, with 4 cases from the mucous layer and the rest from the muscularis mucosa. Lipomyomas showed high level echo and all of them came from the submucosa. Venous sinuses showed no echo and all of them came from the submuscosa. Paplilomas revealed high level echo and all of them came from the mucous layer. Hematoma revealed high level echo and all of them came from the submuscosa. Inflammations and ulcerations revealed low level echo and all of them came from the mucous layer. Squamous hyperplasias revealed high level echo and all of them came from the mucous layer. Polypuses revealed low level echo and came from the mucous layer. Myoblasts revealed low level echo and all of them came from the muscularis mucosa. Glomus tumors revealed low level echo and came from the submucosa. Lymphangiomas showed no echo and derived from the submucosa.3. The lesion size:203 cases leimyoma of the size≤1.0cm,11 cases between 1.0cm～2.0cm, and 1 case of the size>2.0cm; 26 cases stromal tumor of the size≤1.0cm,26 cases between 1.0cm～2.0cm, and 7 cases of the size>2.0cm; 1 case cysts of the size≤1.0cm,36 cases between 1.0cm～2.0cm, and 1 case of the size >2.0cm; 2 cases cancer and precancerous lesions of the size≤1.0cm,29 cases between 1.0cm～2.0cm, and 5 cases of the size> 2.0cm; 3 cases hemangioma of the size≤1.0cm,4 cases between 1.0cm～2.0cm; 7 cases esophageal mucosal uplift of the size≤1.0cm; 4 cases lipoma of the size≤1.0cm; 2 cases sinus of the size≤1.0cm; 2 cases papilloma of the size≤1.0cm; 2 cases hematoma of the size≤1.0cm; 4 cases inflammation and ulcer of the size≤1.0cm,1 case between 1.0cm～2.0cm; 3 cases squamous cell hyperplasia of the size≤1.0cm; 1 case polyp of the size≤1.0cm; 2 cases myoblast cell tumor of the size ≤1.0cm; 1 case glomus tumor of the size≤1.0cm; 1 case lymphangioma of the size between 1.0cm～2.0cm.4. The coincidence rate between endoscopic ultrasonography and histopathology:Among 427 protruded lesions of esophagus detected by endoscopic ultrasonography, there were 46 cases undergoing endoscopic submucosal dissection (ESD),11 cases endoscopic mucosal resection (EMR), and 8 cases surgical treatment. The results of endoscopic ultrasonography in 61 cases coincided with the final results of histopathological diagnosis, with an overall coincidence rate of 93.85%.Conclusion:Endoscopic ultrasonography is of high value in the location, determination and differential diagnosis of protruded lesions of esophagus. Also, it provides effective bases for clinicians to choose between surgical treatment and minimally invasive therapy under endoscopy, but it still has some difficulties in the differential diagnosis between esophageal leiomyoma and stromal tumor and in differentiating between benign and malignant stromal tumors.