Study On The Characteristics Of Esophageal Submucosal Tumors And The Efficacy Of Endoscopic Diagnosis And Treatment

Objective To investigate the general clinical features of submucosal tumors(SMTs),assess the value of endoscopic ultrasound(EUS)in the diagnosis of esophageal SMTs,as well as the feasibility of endoscopic treatment for esophageal SMTs.Methods A retrospective analysis of 633 patients who were diagnosed and treated at the Digestive Endoscopy Center of the General Hospital of Tianjin Medical University from April 2010 to September 2018 was carried out.All patients detected with endoscopy were further checked by chest CT examination and EUS,and then received endoscopic surgery for histopathological diagnosis of esophageal SMTs.The datas were collected for patient's basic information,lesion features both of endoscopy and EUS,histopathological results and endoscopic treatment.Besides,follow-up for every patient was conducted if possible.The intraoperative diagnosis of original layer and histopathological results were used as the gold standard for original layer and pathological diagnosis,respectively.Summarizing the general clinical features of esophageal SMTs,as well as the characteristics of different types of esophageal SMTs and EUS.The accuracy rate of EUS in original layer and pathological diagnosis were analyzed.En bloc resection rate,procedure-related complications and procedure time were analyzed to evaluate the feasibility of endoscopic treatment for esophageal SMTs.Results 1.A total number of 669 lesions of 633 patients with esophageal SMTs were enrolled in the study,the mean age was 54.06±10.55 years,male: female=1:1.07,and the mean long diameter of the SMTs was 1.21±0.81cm(range 0.2-6.0cm).Most of SMTs were located in the middle(253,37.82%)and lower(248,37.07%)esophagus.Besides,SMTs originated from muscularis mucosa,muscularis propria or submucosa were 64.02%(395/617),33.06%(204/617)and 2.92%(18/617),respectively.The majority of esophageal SMTs were leiomyomas(497,78.89%),followed by cysts(34,5.40%)and stromal tumors(30,4.76%).Other rare types were inflammatory fibrous polyps(9,1.42%),lipoma(9,1.42%),granulosa cell tumors(7,1.11%),papilloma(6,0.95%)and schwannomas(5,0.79%),and the like.The malignant potential of Gastrointestinal stromal tumors was graded to very low risk(28,93.33%)and low risk(2,6.67%).2.Esophageal SMTs were often characterized by a hypoechoic mass originating from the muscularis mucosa under the EUS.The total accuracy rate of EUS in original layer or pathological type were 78.61%(485/617)or 81.99%(396/483),respectively.Meanwhile,the diagnostic accuracy rate of muscularis mucosa or leiomyomas were up to 93.16%(368/395)or 90.05%(382/422),respectively.3.Endoscopic mucosal resection(EMR),endoscopic mucosal dissection(ESD)and endoscopic submucosal tunnel resection(STER)were performed in 27 lesions(4.24%),429 lesions(67.35%)and 181 lesions(28.41%),respectively.616 patients(99.21%)were successfully treated with en bloc resection.54 patients(8.53%)were suffered procedure-related complications,mainly about perforation,but they were cured after conservative treatment quickly.En bolc resection rate was mainly related to adhesion to surrounding tissue(P <0.05),but not related to age,lesion size,original layer,extraluminal growth,pathological type and operation method(P >0.05).Multivariate Logistic regression analysis showed that: ? 2cm,originate from the muscularis propria,and adhesion to surrounding tissue were independent risk factors of perforation after endoscopic therapy for esophageal SMTs.4.None of the 463 patients interviewed had esophageal stenosis after operation.No recurrence was detected by EUS at 3 and 12 months after surgery.Conclusion 1.Most of the esophageal SMTs are benign tumors,which are located in the middle or lower esophagus.Besides,leiomyoma is the most common esophageal SMTs derived from the muscularis mucosa generally.2.EUS has a high diagnostic value for the original layer and pathological types of common esophageal SMTs,and plays a key role in the choice of treatment methods for endoscopic treatment of esophageal SMTs.However,there are limitations for EUS to diagnose rare types of SMTs in the esophagus correctly,and EUS is unable to distinguish the benign lesions from malignant ones.The pathology should be retained according to the specific conditions of the lesions,and then defining the nature of lesions to reduce the risk of malignancy.3.Endoscopic treatment is a safe and effective treatment for esophageal SMTs.Reasonable selection of treatment methods can improve the therapeutic effect of lesions.