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Endoscopic ultrasonography (EUS)is routinely performed before endoscopic submucosal dissection (ESD)for treatment of upper gastrointestinal stromal tumors.However,when a miniprobe sonography (12,15 and 20 MHz)was used,the size of tumor revealed by EUS was often inconsistent with what it actually was,which might increase the difficulty of ESD and the risk of perforation and massive bleeding.Aims:To investigate the value of standard probe (5 and 7.5 MHz)EUS in detecting the size of upper gastrointestinal stromal tumors before ESD.Methods:Clinical data of patients who were suspicious of esophageal and gastric stromal tumors by gastroscopy and EUS from Jan.2012 to Oct.2014 at the Renmin Hospital of Wuhan University were collected.Of them,195 cases treated by ESD were retrospectively analyzed.Results:Of 195 cases treated by ESD,37 cases diagnosed by standard probe EUS and 108 cases diagnosed by miniprobe EUS were confirmed as stromal tumors by pathology.Fourteen cases were failure for ESD and then transferred to surgical treatment,one was due to misjudgement of the origin of tumor by standard probe EUS and 9 were due to misjudgement of the size of tumor by miniprobe EUS.The misjudgement rate of standard probe EUS was lower than that of miniprobe EUS with an insignificant difference (2.7%vs.8.3%,P>0.05).In 9 cases misjudged by miniprobe EUS, the size of tumor presented by miniprobe EUS was significantly smaller than its real size [(1.22 ±0.51)cm vs.(3.97 ±1.06)cm,P<0.01].ESD was avoided or terminated in 3 cases because of the accurate estimation of tumor origin, structure and blood flow by standard probe EUS.Conclusions:For patients who are going to receive ESD for suspected upper gastrointestinal stromal tumors,it would be best to select standard probe EUS to detect the size,origin and blood flow of the tumor before ESD.It will decrease the risk and improve the success rate of ESD.
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Objective To evaluate the lfexible spectral imaging color enhancement (FICE) system associated with mini-probe endoscopic ultrasonography in diagnosis of superifcial esophageal lesions.Methods 292 patients with superficial esophageal lesions were randomly assigned to control group or observation group. The common white light endoscopy and magnifying endoscopy were used in the control group while FICE associated with mini-probe endoscopic ultrasonography in the observation group. Findings were compared with the pathologic diagnosis.Result The magnifying FICE could reveal the IPCL of superifcial esophageal lesions and can accurately determine the pathological types of lesions. The diagnose accordance rate of esophagitis by magnifying FICE was 82.69%, mild and moderate atypical hyperplasia highly atypical hyperplasia 86.96%. The diagnostic accuracy rate of esophagus lesions between observation group and control group was 91.78 %, 76.02 % respectively. And the diagnostic sensitive rate between two groups was 85.71%, 44.44%. The former is superior to the latter. There were 5 lfat lesions found by FICE which were missed diagnosed by white light endoscopy.Conclusion FICE can enhance the ability of identiifcation of lesion which shows the outline and morphology of lesion and can improve the biopsy accuracy. FICE associated with mini-probe endoscopic ultrasonography has a certain clinical application value in the diagnosis and treatment of superifcial esophageal lesions.
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Objective To explore the value of miniprobe sonography (MPS) in differentiating Crohn??s disease (CD) and ulcerative colitis (UC). Methods 46 patients with active inflammatory bowel disease (IBD) were included into the patient group (16 patients with CD and 30 cases with UC). 20 healthy cases ( underwent physical examination in outpatient department) were recruited as the control group. All cases underwent MPS and high sensitive C-reactive protein (Hs-CRP) test.The MPS measurement index include thetotalwallthickness(TWT), mucosal thickness (MT), submucosal thickness (SMT), muscularispropria thickness (MPT), and the number of enlarged colic and paracolic lymph nodes. Results TheTWT, M, SM, MP(mm)and Hs-CRP(mg/L)in CD, UC and control group are 5.84 ± 1.42, 1.48 ± 0.23, 1.88 ± 0.28, 2.31 ± 0.85, 40.58 ± 19.33, 4.74 ± 1.01, 1.79 ± 0.35, 1.41 ± 0.25, 1.32 ± 0.34, 22.41 ± 15.25,2.86 ± 0.23, 0.97 ± 0.13, 1.06 ± 0.11, 0.64 ± 0.0 and 1.70 ± 0.65. TWT, MT, SMT, MPT and Hs-CRP in UC group has significant different with those in controp group(P<0.05). The mean value of TWT, MT, SMT, MPT and Hs-CRP in CD group are higher than those in UC group. M in UC group is higher than that in CE group. The difference is significant(P<0.05). 5 cases in CD and 2 cases with UC had enlarged colic or paracolic lymph nodes. Conclusions The MPS can distinctly observe the changesof different colonic tissue layers and the surrounding tissue structures in IBD patients,which helps for distinguishing active CD from UC.
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Objective To evaluate the diagnosic value of miniprobe sonography (MPS) in eminence lesion of upper gastrointes-itinal tract .Methods MPS were performed in 485 patients with eminence lesion of upper gastrointesitinal tract .334 patients were given histologic examination .The pathological examination results were compared with diagnosis of MPS and gastroenterology .Re-sults 80 stromal tumors ,41 leiomyomas ,22 cases of ectopic pancreases ,67 cancers ,28 cysts ,26 lipomas ,25 hemangioma ,42 in-flammatory hyperplasia ,104 polyps ,25 cases of protuberance from outside organs ,1 lymphoma and 8 cases of duodenal Brunner gland hyperplasia were detected .The accurancy rate of MPS was 76 .65% which is higher than gastroscope′s .Conclusion MPS is helpful to scope the extent and location of the eminence lesion of upper gastrointesitinal tract and display security of endoscopic bi-opsy .M PS do benefit to the diagnosis ,differential diagnosis and treatment of eminence lesion of upper gastrointesitinal tract .
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Objective To raise diagnostic rate of protruded lesion of gastrointestinal mucosa and to judge the precise differentiation to the depth of malignant lesion.Methods 12 cases of gastrointestinal diseases were examined by MPS combined with endoscopic examination.Results To the patients suffering protruded lesion of gastrointestinal mucosa with negative biopsy,the MPS provided a sound basis for diagnosis;To the cases of malignant lesion,findings of MPS with regard to the depth were in total concordance with that of surgical biopsy.Conclusion MPS is significanfly superior to conventional endoscopy with pathological biopsy in the differentation of protruded lesion of gastrointestinal mucosa.But in the case of malignant lesion,only the depth of infiltration of gastrointestinal wall can be correctly assessed by MPS.The value is limited in showing whole Picture for larger focus and in the identification of around lymphnodes and whether or no distal metastases in the near organs.