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Objective To investigate the role of endoscopic ultrasonography (EUS) in diagnosis and treatment of colorectal submucosal lesions. Methods EUS were applied in 74 patients with suspected colorectal submucosal lesions. According to the origin of submucosal lesion, the patients had received biopsy, endoscopic ultrasonography-fine needle aspiration (EUS-FNA) and endoscopic treatment or surgery. The correlation between EUS and clinical pathology is analyzed retrospectively. Results In the diagnosis based on EUS, there were 28 cases of neuroendocrine tumors (occurred in the rectum), 15 lipomas (4 cases occurred in ileocecal, 1 in transverse colon, 8 in ascending colon, 2 in sigmoid colon), 2 rectal gastrointestinal stromal tumor (1 in muscularis propria and the other in muscularis mucosa), 14 external pressure changes (9 ovarian tumor, 2 lymph nodes, 3 pelvic tumor), 5 cyst (4 in transverse colon, 1 in ascending colon), 1 gas cyst, 3 sigmoid colon endometriosis, 4 rectum malignant tumor invasion, 2 intestinal lymphoma. All the patients had received biopsy, EUS-FNA, endoscopic treatment or surgery. Compared with pathology, a total coincidence rate of 91.9% (68/74) was achieved by EUS, and 2 cases were pathologically diagnosed as leiomyoma, which is considered as rectal carcinoma by EUS at first, 1 case of intestinal lymphoma instead of lipoma, 2 inflammatory mass instead of malignant tumor around the rectum, and 1 rectal carcinoma instead of endometriosis. Conclusion The digestive tract structure could be showed clearly with EUS, and the size of the colon and rectal submucosal lesions, the layer of origin and the structural relationship of adjacent tissues could also be detected. Then, the appropriate treatment against the colon and rectal submucosal lesions would be adopted after the accurate judgment of lesions with EUS.
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Objective To find the related factors of the unsuccessful unsedated colonoscopy. Methods Clinical data of 1 726 consecutive subjects who underwent colonoscopy without sedation from April 2014 to January 2015 at the second affiliated hospital of Soochow university were analyzed. Data included characteristics of the patients (age, gender, body mass index, degree of education, the bowel-cleaning drugs, previous colonoscopy experience, bowel habits, history of chronic disease, history of sport, history of abdominal or pelvic surgery, the indication of colonoscopy, mood, quality of bowel preparation, and presence/absence of colonic diverticulum), the characteristics of the physicians (procedure experience, the instrument handling method). These factors were analyzed to evaluate their impact on result of unsedated colonoscopy. Results This study included 1 726 patients (male/female: 927/799). These patients' average age was 50.04 years old, the cecal intubation rate was 91.6%, and the average intubation time was 10.27 minutes. The multiple regression analysis showed the elderly patient, lower BMI, irritability, consti﹣pation, poor bowel preparation were associated with the lower cecal intubation rate. Conclusions The elderly patient, lower BMI, irritability, constipation and poor bowel preparation were associated with the failure of unsedated colonoscopy. In clinical practice, quality improvement programs are needed to improve the rate of total colonoscopy.