The Characteristics Of Submucosal Lesions In Gastrointestinal Tract With EUS, CT And Histopathology

?Background and Objective?Protuberances in gastrointestinal tract are defined as intraluminal protuberant lesions discovered by ordinary endoscopy or other examinations. Its mucosal surface is normal or close to normal. Mucosa and submucosal lesions in gastrointestinal tract, extrinsic compression or others are the pathogeny of protuberances, while submucosal lesion(SML) is the most common one, which includes liomyoma, gastrointestinal stromal tumors(GIST), lipoma, neuroendocrine tumors, heterotopic pancreas etc. Depending on diverse lesion location, protuberances in gastrointestinal tract could arouse various clinical symptoms, but the symptoms in most of the patients are lack of reference values. The diagnosis and treatment of submucosal lesion in gastrointestinal tract has always been a hot issue and difficulty in domestic and overseas clinical practice of gastroenterology department. Generally, ordinary endoscopy is difficult to distinguish the benign and malignant of submucosal lesions in gastrointestinal tract, as well as the origin and the depth of invasion. Nevertheless, Endoscopic ultrasonography(EUS) solves the problem in diagnosis. Moreover, EUS could identify the nature of the lesion and the depth of invasion and further provide guidance for future treatment. Based on the origin and depth of invasion of protuberances, therapies are confirmed, such as endoscopic technologies, as well as laparoscopic surgery or laparotomy. From January 2013 to December 2015, a total of 86 consecutive patients with SML in gastrointestinal tract were diagnosed in our department. All of them were carefully evaluated for the disease, subjected to other examinations such as CT and ordinary endoscopy, and signed the informed consent before they received EUS examination. Then they were further subjected to endoscopic treatment and got the accurate pathological diagnosis. Meanwhile, we gathered the data of patients about conditions of the examinations, diagnosis and endoscopic treatment. Now we retrospectively analyzed the data, and study the characteristics of submucosal lesions in gastrointestinal tract with EUS, CT and histopathology. The current study may provide new clinical insights concerning diagnosis and treatment of submucosal lesions in gastrointestinal tract. ?Methods?A total of 86 consecutive patients with SML in gastrointestinal tract from January 2013 to December 2015 were diagnosed by physicians in our department. All the patients underwent EUS, with the location, size, source and echo of the nidus noted, and then were subjected to the endoscopical therapy based on examination results to remove the tissue of SMT in gastrointestinal tract. Next, we conducted histopathologic examination and obtained the histopathological diagnosis. According to the patients' data, we analyzed the diagnostic consistency between EUS and histopathologic examination and summarized the characteristics of ultrasound and origin of SMT; Ordinary endoscopy were conducted among 86 patients before they went to hospital, and diagnostic consistency between ordinary endoscopy and histopathologic examination and other issues were performed; Chest and abdomen CT were conducted among 86 patients when they went to hospital, and diagnostic consistency between CT and histopathologic examination and other issues were discussed; The examination, diagnosis, endoscopic treatment effect and prognosis etc from 86 patients were evaluated and analyzed to further assess significance of EUS, CT and histopathology for the diagnosis and treatment of SML in gastrointestinal tract. ?Results?We performed EUS and endoscopic treatment for 86 patients. 62 of the cases whose diagnosis of endoscopic ultrasonography were consistent with postoperative pathological diagnosis and the total coincidence rate was 72.1%(62/86). Ordinary endoscopy was executed to all the 86 patients, 45 of 86 cases were consistent with postoperative pathological diagnosis, and the coincidence rate was 52.3%(45/86). Moreover, diagnosis was consistent in 40 cases from both endoscopic ultrasonography and ordinary endoscopy diagnosis, with the coincidence rate 46.5%(40/86). We applied matching ?2 test and calculated ?2=9.45(P < 0.005). According to the ?=0.05 level, the difference is statistically significant. CT examination of chest and abdomen was conducted to all the 86 patients. 40 of 86 cases were consistent with postoperative pathological diagnosis, and the coincidence rate was 46.5%(40/86). Moreover, 35 cases were diagnosed consistently both by endoscopic ultrasonography and CT diagnosis, with the coincidence rate 40.7%(35/86). We applied matching ?2 test and calculated ?2=13.8(P < 0.005). According to the ?=0.05 level, the difference is statistically significant. Combination with comprehensive assessment of the patients' condition and the result of endoscopic ultrasonography, all patients(n=86)were subjected to endoscopic treatment. 2 patients failed the treatment, and the success rate was 97.7%(84/86). 5 of 86 cases got operative complications, and the incidence of operative complications was 5.8%. We continued to visit the patients after hospital discharge. Until December 2015, none of the 86 patients got relapse. The recurrence rate was 0% after endoscopic treatment. ?Conclusions? 1. Esophageal liomyoma is the most common SMT in gastrointestinal tract, which always occurs in upper esophagus and lower esophagus, especially in female, and among people from 35 to 70 years old; GIST which always occurs in the fundus of stomach and the body of stomach and gastric lipom which always occurs in the gastric antrum are the most common SMT in stomach. 2. EUS has high accuracy in the diagnosis of protuberances in gastrointestinal tract and is superior to CT and ordinary endoscopy. 3. In the SMT in gastrointestinal tract, we find:(1)Most of the liomyoma derive from muscularis mucosa with homogeneous hypoecho, clear boundary, and sometimes, high level echo are found in the central region of the nidus;(2)Most of the GISTs, like oval or lobulated shape, derive from muscularis propria with hypoecho and homogeneous or heterogeneous echo inside;(3)Most of the lipoma come from submucosa with high-level echo, clear boundary, homogeneous echo inside and the distinct attenuation of far echo;(4)With the hypoecho, most of the gastrointestinal neuroendocrine tumors lack of the characteristic expression;(5)Most of heterotopic pancreas express medium-low echo or high level echo with uneven echo in the lesions. 4. With the advantage in high diagnostic value for the diagnosis of SML in gastrointestinal tract, EUS can accurate locate and evaluate the nidus as well as guide the subsequent treatment of lesions. 5. The endoscopic treatment under the guidance of EUS is safe, effective, and has high success rate, less complications, rapid recovery. Patients can benefit more from the treatment.