Clinical Value Of Endoscopic Ultrasonography In Preoperative Assessment And Risk Of Gastric Stromal Tumor

Background and ObjectiveGastrointestinal stromal tumors(GISTs)are a kind of mesenchymal tumors originating from Cajal cells in the digestive tract.The primary lesions of GISTs can be found in the whole gastrointestinal tract.The mucosal or muscularis of the organ of the organ grows up to the stomach(about 70%),so this study will focus on Gastric stromal tumors(GSTs).There is no obvious specific clinical manifestation of GSTs in the early stage.Patients with abdominal growth,abdominal gastrointestinal bleeding or compression symptoms may develop with tumor growth,but these clinical symptoms are also non-specific.Previous studies have suggested that GISTs will undergo malignant changes at a certain stage of growth.Some studies have found that some GISTs have high malignant risk characteristics in the early stage of growth.With the development of endoscopic techniques,more and more early GISTs can be detected,and GSTs usually grow in the muscularis of the digestive tract,and a small part grows in the mucosal or submucosal layer,but this is for ordinary digestive endoscopy.Endoscopic ultrasonography(EUS)is currently the most accurate and effective method for assessing Submucosal tumors(SMTs),which can be passed through endoscopic lenses.The pre-existing ultrasonic probe echoes the mucosa(hyperechoic),muscularis mucosae(hypoechoic),submucosa(hyperechoic),muscularis propria(hypoechoic),and serosa(hyperechoic).Five clear levels to observe and evaluate lesions under the mucosa.Endoscopic ultrasonography-guide fine needle aspiration(EUS-FNA)can also be used to obtain tissue from tumors for preoperative histopathological diagnosis.However,the results of puncture of GISTs are often insufficient due to tissue sampling,and the operation of EUS-FNA destroys tumor integrity and greatly increases the risk of gastrointestinal bleeding and peritoneal implantation.Therefore,this study looks for factors in non-invasive EUS examination.It is related to the high risk of GSTs and guides the timing of surgery.GSTs are usually the first choice for the treatment of complete resection of the lesion(R0).For early GSTs with R0,digestive endoscopic minimally invasive surgery is a higher benefit than conventional surgery or laparoscopic surgery.In this study,preoperative EUS Doppler flow imaging was used to compare GSTs with different blood flow information,aiming at observing different blood supply tumors,the surgical procedure and results.The impact of providing guidance on the management of GSTs can also provide useful evidence for the need for preoperative EUS precision interrupted intervention or other endoscopic treatment of GISTs.MethodsPatients with gastrointestinal stromal tumors(GSTs)who were treated in our Department of Gastroenterology from September 2016 to September 2018.According to the classification of risk of GSTs pathology,the degree of blood flow information of tumors were compared by grouping.The results of preoperative EUS examination of GSTs tumor growth location,size,shape,endoscopic image characteristics,internal echo characteristics,elastography scores,harmonic enhancement,etc.;all patients underwent endoscopic minimally invasive surgery,Relevant medical records such as blood loss,vascular injury rate,postoperative complications and postoperative hospital stay.Results(1)1)A total of 237 cases of gastric stromal tumors were diagnosed during the study data collection.After excluding each exclusion criteria one by one,the remaining 95 cases were included in this study;(2)According to the endoscopic Doppler flow signal,95 cases were divided into the blood supply group(53,55.8%)and the blood supply group(42,44.2%),the time-consuming,bleeding volume,surgical vascular injury rate,and average postoperative hospital stay of the blood-rich group were greater than those in the blood-supplemented group,P<0.05.Postoperative complications occurred in the two groups.There was no significant difference in the rate,P>0.05.(3)According to the Fletcher risk classification,it was divided into low-risk group(63 cases),intermediate-risk group(22 cases),high-risk group(10 cases),and GSTs were found to be irregular in shape,blurred in boundary,uneven in internal echo,internal calcification,Liquefaction,elastic score ? 3 and Contrast-enhanced harmonic endoscopic ultrasonography(CH-EUS)non-uniform enhancement and super-enhancement may indicate that the tumors has a higher risk grade,P<0.05;(4)GSTs size,growth site,surface mucosa characteristics and internal The blood flow signal was not related to the risk grade.ConclusionIn this study,we compared the results of preoperative EUS with postoperative pathology and immunohistochemistry,and found that EUS non-invasive examination has a high guiding value for the risk classification of GSTs,especially ultrasound endoscopic elastography and contrast harmonic enhanced ultrasound technology.It can be used in the risk grading diagnosis of GSTs,and the provided blood supply information can help to evaluate the safety of surgery and the treatment management of clinical patients.