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Objective To evaluate the valuse of endoscopic ultrasonography ( EUS ) for upper gastrointestinal submucosal lesions and the role of Photoshop in differentiating leiomyoma and stromal tumors. Methods Data of 656 patients with upper gastrointestinal submucosal lesions evaluated by EUS and receiving endoscopic submucosal dissection ( ESD ) from April 2010 to March 2015 were collected and retrospectively analyzed. The goldern standard for lesions size and origin was the intraoperative diagnosis of ESD, and that of the type of lesions ( leiomyoma, stromal tumor, ectopic pancreas, lipoma, etc.) was pathological and immunohistochemical finding. The consistency of diagnosis of the EUS was evaluated. In addition, Photoshop was used to differentiate diagnosis of leiomyoma and stromal tumors which were confirmed by pathology and immunohistochemistry. Results The consistency in diagnosing the size and lesion origins was 92?56%(560/605) and 88?43%(535/605)between EUS and ESD intraoperative result. The consistency in pathological types of EUS was 79?34%(480/605). Photoshop was used to analyze the EUS images of 177 stromal tumor and 241 leiomyoma. The gray value of stromal tumor was significantly higher than that of leiomyoma(59?97 VS 39?39, t=43?27, P<0?05).The echo of stromal tumor was higher. The standard deviation of gray value of leiomyoma were significantly lower than that of the stromal tumor ( 4?81 VS 5?42, t = 2?83, P < 0?05 ) , indicating the echo uniformity of leiomyoma was better. Conclusion EUS shows high accuracy rate for upper gastrointestinal submucosal lesions, providing more accurate basis for endoscopic therapy. EUS combined with Photoshop is helpful for differentiating stromal tumor from leiomyoma.
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Objective To assess the relationship between the recurrence of esophageal varices fol?lowing endoscopic esophageal varix ligation (EVL) and esophageal collateral veins(ECV)under endoscopic ultrasound ( EUS) , and analyze the predictive value of EUS for recurrence of esophageal varices. Methods Sixty patients with cirrhotic portal hypertension combined with esophageal varices underwent EVL for eradica?tion of varices. Endoscopy and EUS were performed before ligation to detect and describe the type of esopha?geal varices, and grade, location, and the number of ECV. Over a 12?month period, variceal recurrence was examined. The statistical analyses were performed to assess the relationship between esophageal varices fol?lowing EVL and ECV. Results Of the 60 patients, 29 ( 48?3%) had variceal recurrence within 12 months after EVL. Univariate logistic regression analysis showed that severe peri?ECV ( OR=22?67;95%CI:4?37? 117?47, P<0?001) ,severe para?ECV( OR=16?31;95%CI:0?84?108?14, P=0?018) , multiple peri?ECV ( OR=22?67;95%CI:4?37?117?47, P<0?001) , and the presence of perforating veins ( OR=6?67,95%CI:1?46?30?43,P=0?014) were significantly related to the variceal recurrence after EVL. Multivariate logis?tic regression model showed that severe peri?ECV ( OR=24?39;95%CI:2?34?253?78,P=0?008) and mul?tiple peri?ECV (OR=24?39;95%CI: 2?34?253?78,P=0?008) severe para?ECV(OR=19?42; 95%CI:4?84?148?54,P=0?012) remained independent prognostic factors for variceal recurrence. The sensitivity and specificity of multivariate logistic regression model in predicting variceal recurrence were 89?2% and 90?5%, respectively (prognostic value AUC=0?946).The sensitivity and specificity were 86?4% and 87?7% in pre?dicting variceal recurrence( prognostic value AUC=0?871) . Conclusion Recurrence rate of esophageal var?ices after EVL is high. EUS can clearly depict ECV. Severe peri?ECV and multiple peri?ECV are significant and independent prognostic factors associated with variceal recurrence risk. EUS before EVL will help predict variceal recurrence after EVL.
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Objective To evaluate technical efficacy,feasibility and safety of a fully covered self-expanding metal stent for EUS-guided transgastric pancreatic pseudocyst drainage. Methods Data of a total of 11 patients who received EUS-guided transgastric pancreatic pseudocyst drainage with a covered self-ex-panding metal stent at Changhai Hospital from September 2013 to May 2014 were retrospectively studied. The manipulative success rates,curative success rates and complication rates were evaluated. Results All 11 patients were treated by EUS-guided transgastric pancreatic pseudocyst drainage with fully covered self-ex-panding metal stents successfully,with success rate of 100%. Two patients developed infection and displace-ment occurred in 1 patient. There was no hemorrhage,perforation or death. Stents were removed in 7 pa-tients and the pseudocysts vanished. Conclusion Endosonography-guided transgastric pancreatic pseudocyst drainage using a fully covered self-expanding metal stent can be accomplished with high technical and clinical success rate and low rate of complications.
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Objective To evaluate the significance of color Doppler EUS in the pancreatic pseudo-cysts drainage. Methods EUS - guided cystoenterostomy was performed in 3 patients. A needle and drainage tube was inserted in a one - step procedure into the cyst through the accessory channel of echoendoscope under EUS. The nasal plastic drainage tube was released immediately after insertion. Results When gastric ulcer and bleeding or the bulge of stomach were not found endoscopically in all patients . The needle with its stylet inserted through the gastric wall into the cyst at the site with minimal distance between them . The mean size of the pseudocysts was approximately 8 cm located at pancreatic tail ,body or the junction of them. In 3 cases but one, the blood flow signal around the cyst was not found . No significant echo of laminated structure between gastric and cyst wall was found . After aspiration or installation of naso-cystic drainage catheter, abdominal pain remitted at 2 days, 2 days and 3 days; the sonography demonstrated that cyst size decreased began from 3rd day ,and the cyst obliterated at 14 and 30 days after drainage. The only complication was found in one patient with gastric mucosal ooze, which recovered after noradrenaline spray . Infection or perforation never occurred. No recurrence of pseudocysts observed at a mean follow - up period of 3. 6 months (range 2-7 months). Conclusions The EUS-guided drainage of pancreatic pseudocysts in one-step is a rather simple and practical procedure with minimal risk of hemorrhage and infection.