内镜黏膜下剥离术在早期胃肠肿瘤中的应用与评价

胃肠道早期癌肿是指病变局限于黏膜或黏膜下层而未达肌层。无论病灶大小及是否有淋巴转移。随着染色内镜、放大内镜和超声内镜等消化内镜诊断新技术的开展．越来越多的早期胃肠肿瘤可以被发现并得到准确诊断。将内镜检查发现的胃肠道局部病变进行内镜下微创切除．一直是内镜医师梦寐以求并为之努力的奋斗目标。     

小探头超声内镜在治疗食管黏膜下肿瘤中的应用价值

食管黏膜下肿瘤是内镜检查时较常见的病变,常规内镜常无法准确判断其来源、性质和大小。盲目切除食管黏膜下肿瘤易发生穿孔及大出血等并发症。使用小探头超声内镜（miniprobe sonography,MPS）能对黏膜下肿瘤进行超声扫描,了解其结构、大小及来源,根据超声内镜检查结果决定治疗方案,降低了手术的风险,可以很好地解决上述难题。近年来,我们采用MPS对48例食管黏膜隆起性病变进行检查,现将结果分析如下,以探讨MPS在食管黏膜下肿瘤中的应用价值。     

大肠类癌的内镜及超声内镜特点

目的 探讨大肠类癌的内镜及超声内镜特点,提高内镜诊疗水平.方法 收集2002-2007年收治的22例大肠类癌患者的临床资料.分析内镜及超声内镜特点及其与浸润深度的关系.结果 早期癌内镜表现为直径1.5cm、黏膜光滑、黏膜内黄白色颗粒样结构;进展期癌内镜表现为直径0.8～3.0cm、黏膜不平、黄白色结节样或表面溃疡.超声内镜特征为:稍低回声,内部散在点状稍高回声,起源于黏膜固有层或黏膜下层不规则卵圆形结构,边缘模糊且不规则.16例黏膜内癌及黏膜下浅层癌行内镜黏膜切除术,其中10例追加氩气刀治疗.随访4～36个月无复发.1例黏膜下深层类癌及5例进展期类癌行外科手术.结论 内镜及超声内镜可诊断大肠类癌及其浸润深度,对早期类癌行内镜治疗可取得较好效果.     

消化道黏膜下肿瘤内镜微创切除新技术的开展及评价

消化道黏膜下肿瘤（submucosal tumor,SMT）泛指一类来源于黏膜以下的消化道病变。内镜和超声内镜检查均无法定性诊断．长期随访会造成患者的巨大负担。我国学者在内镜黏膜下剥离术发展的基础上,大胆尝试内镜切除消化道黏膜下肿瘤．既能得到正确的诊断,又能起到治疗的目的．本文就各种内镜下切除消化道SMT的指征、方法以及疗效等作出评价。     

国内内镜超声检查术的应用现状

1980年,Dimagno及Hisanaga首次报告将超声传感器安装在消化内镜的顶端开展了消化管腔内的内镜超声检查术(endoscopic ultrasonography,EUS)。时隔8年,第一台机械扇型扫描超声内镜于1988年引进我国;当前,我国共有正规的超声内镜约20余台,按我国的省份平均计算,每个省尚不足一台,说明EUS在我国的应用尚不够普及。 虽然我国超声内镜的数量尚不够多,应用EUS的历史也仅十年,但迄今为止几乎所有最先进的超声内镜设备及各种频率的细径超声探头已被逐年     

超声大肠镜检查在直肠肿瘤诊断中的应用

直肠肿瘤术前诊断至关重要,纤维及电子内窥镜的应用为直肠肿瘤的诊断提供了很大便利.近年来内镜超声(en-doscopic utrasonograp,EUS)作为一种新型的检查仪器已逐渐在临床上应用,它具有普通大肠镜及超大型声功能.应用该种仪器可以观察病变所在的层次(包括判断是否为粘膜下肿物)及周围淋巴结情况.我信应用EUS检查直肠病菌变10例,其中8例经手术治疗,1例经内镜治疗,1例随诊观察.本研究目的在于比较判断EUS对直肠病变术前临床分期诊断的准确性,以评价EUS在直肠病变术前临床分期及指导选择适当的治疗方式方面的应用价值.     

内镜超声检查术在消化道外科疾病诊治中的应用

内镜超声检查术(ultrasonic endo-scope,EUS)最早于1980年由美国的DiMagno首次报告应用,近年来,随着腔内超声新器械的不断开发,适合消化系各种管腔,且有多种频率的超声内镜被广泛应用于临床,极大地拓宽了EUS在消化系疾病中的诊疗范围。在诊断方面,超声内镜的发展有利于某些消化系疾病手术方式的选择,在治疗方面,超声内镜微创介入治疗技术的发展,在某些疾病甚至取代了外科手术治疗。一、EUS在胃肠道疾病中的应用由于EUS是胃镜和超声的结合,因而具备其特有的优势。既能观察到消化道黏膜的情况,如溃疡、糜烂、黏膜隆起等,又能显示消化道…     

上尿路腔内导管超声的临床应用评价

目的 评价腔内导管超声诊断上尿路疾病的可行性和有效性. 方法上尿路疾病患者68例.男30例,女38例.年龄17～81岁,平均58岁.采用频率10 MHz、外径8 F微探头腔内导管超声探测显示肾盂及周围病变48例,输尿管及周围病变20例;其中双侧检测2例,随访检测3例,共73例次.根据患者病变病理或临床随访结果评价腔内导管超声诊断的有效性.结果 68例患者中,成功检测62例(91%),其中肾盂及周围病变46例(96%)、输尿管及周围病变16例(80%).导管超声检出肾盂及周围病变异常41例(89%),其中经手术病理诊断28例、经临床随访和根据其他检查确诊7例、未被证实6例;检出输尿管及周围病变异常者12例(75%).20例输尿管及周围病变者中经手术病理诊断或临床随访和根据其他检查确诊18例,14例行输尿管手术,输尿管微结石4例采用保守治疗.结论 上尿路腔内微探头导管超声探测能清晰显示腔内病灶的形态、大小、回声和部位,而且能精细、准确、实时地显示腔外结构,为上尿路疾病诊断提供了一种新方法.     

内镜黏膜下隧道法切除早期食管癌及癌前病变的应用分析

目的 探讨内镜黏膜下隧道法在切除早期食管癌及癌前病变中的应用价值.方法 17例术前超声内镜检查判断病变局限于黏膜层,经黏膜活检发现食管上皮局灶癌变或重度不典型增生的患者,采用黏膜下隧道法的内镜下早期癌切除.结果 17例中,术后病理确诊鳞状上皮增生伴黏膜慢性炎4例,重度不典型增生5例,高至中分化鳞癌8例,其中T1a期7例,T1b期1例.有2例切除黏膜边缘重度不典型增生,1例黏膜下层切缘见癌细胞,其余病例均病灶完整切除.术后1例患者因迟发性出血转开胸手术治疗,其余患者均恢复良好.结论 黏膜下隧道法切除黏膜内早期食管癌及癌前病变安全、有效,更符合直视、充分暴露的外科原则,明显减少出血、穿孔的并发症风险,但其对病灶切除范围判断有一定困难,需在手术中充分注意.     

小胃肠间质瘤的内镜下诊断和治疗研究进展

胃肠间质瘤( GIST)是胃肠道最常见的间叶源性肿瘤,其发病隐匿,特别是小胃肠间质瘤往往是在普通内镜检查中发现,而由于其是黏膜下病变,明确诊断困难,治疗方法选择意见不统一。近年来,随着内镜设备和技术的发展,特别是超声内镜检查和多种内镜治疗技术的应用,包括内镜下套扎术( EBL)、内镜经黏膜下隧道肿瘤切除术( STER)、内镜黏膜下剥离术( ESD)、内镜黏膜下挖除术( ESE)、内镜下全层切除术( EFTR)和腹腔镜和内镜联合手术( LECS),明显提高了小胃肠间质瘤的诊断和治疗水平,现从小胃肠间质瘤的内镜下诊断方法和内镜下治疗方式的选择进行综述。     

Endoscopic ultrasonography in the diagnosis and management of suspected upper gastrointestinal submucosal tumours

BACKGROUND: 'Submucosal' lesions in the upper gastrointestinal tract are often difficult to evaluate. Endoscopic ultrasonography (EUS) provides high-quality information about the nature of these lesions and may assist management. This study assessed the use of EUS in the evaluation and management of upper gastrointestinal submucosal tumours. METHODS: Forty-four consecutive patients were referred with suspected upper gastrointestinal submucosal lesions for EUS. All examinations were performed by one of two experienced endosonographers. RESULTS: Most patients were referred for EUS with a suspected gastrointestinal stromal tumour. The pre-EUS diagnosis did not correlate with the EUS diagnosis in 25 of 44 patients. Pathological correlation was possible in 16 patients, and the EUS diagnosis was confirmed in each case. Based on the findings at EUS, 12 patients underwent resection. Pathology confirmed the ultrasonographic findings in these patients. Follow-up EUS to monitor lesions was recommended in a further three patients. CONCLUSION: EUS is safe and provides useful information in many patients with suspected submucosal tumours. EUS may reveal unsuspected findings and can increase physician certainty, allowing accurate diagnosis and facilitation of the management process.     

Current clinical applications of endoscopic ultrasound

Endoscopic ultrasound (EUS) has been developed since the early 1980s. Its clinical role in the diagnosis of gastrointestinal wall lesions and staging of gastrointestinal and lung cancer has evolved over the last two decades. Initially, it was either used as an imaging tool for gastrointestinal wall lesions or for staging of gastrointestinal tumours. However, in combination with fine-needle aspiration under real-time scanning, EUS is now being used in tissue sampling for diagnosis. In addition, EUS may be used therapeutically in coeliac plexus neurolysis or pseudocyst drainage. This review concentrates on the current applications of EUS.     

Endoscopic ultrasound examination of the upper gastrointestinal tract using a curved-array transducer

Summary Endoscopic ultrasound examination (EUS) of the upper gastrointestinal (GI) tract for the assessment of mural and extramural pathology has attracted growing international interest in recent years. Since February 1989, EUS has been performed on selected patients in our institution using a new Picker-Pentax fiber-optic ultrasound (US) gastroscope. The instrument consists of a forward-view fiber-optic gastroscope with a 5-MHz curved-array linear US transducer mounted directly behind the lens. The scanning plane lies in the long axis of the scope. Based on in vitro US examinations and EUS of 118 patients over an 18-month period, our preliminary experience with the instrument is described. Using EUS, various lesions in the esophageal wall as well as in the gastric and duodenal walls can be visualized. Furthermore, organs and structures outside the GI tract can be seen, and lesions such as enlarged lymph nodes in the mediastinum and abdomen; solid and cystic masses in the liver, pancreas and retroperitoneum; arterial aneurysms; esophageal varices; and gall stones and calcifications can be demonstrated. The 5-MHz transducer does not provide very detailed information on the GI wall. The direction of the ultrasound scanning planes is difficult to define, as the transducer cannot be seen through the optic lens. The method demands great expertise in endoscopy and ultrasound. Indications for EUS have not been definitively established. Evaluation of the diagnostic accuracy of this technique requires further controlled studies. We believe that EUS using a curved-array linear transducer will provide significant diagnostic information of clinical relevance to gastroenterology.     

超声内镜在消化系肿瘤诊疗中的应用

超声内镜自从应用于临床以来．已被认为是一种非常有价值的诊断消化系肿瘤并可对其进行TNM分期的工具。过去的十几年,随着穿刺器械的改进,超声内镜引导下细针抽吸活检迅速发展起来．为超声内镜的治疗性应用开辟了一条崭新的道路。目前,超声内镜已被广泛应用于消化系肿瘤的诊断与治疗中。本文就超声内镜在消化系肿瘤的诊治应用进展进行阐述。     

EUS-guided Trucut needle biopsies as first-line diagnostic method for patients with intestinal or extraintestinal mass lesions

Introduction

Fine-needle aspiration (FNA) is a well-established technique to obtain cytological specimens, but it does not permit the extraction of histological tissue-core samples, which, if available, may increase the yield and accuracy of the histopathological diagnosis. This prospective study was designed to assess the yield and diagnostic accuracy of endoscopic ultrasound (EUS)-guided Trucut needle biopsy (TNB) as first-line diagnostic method for suspected malignant lesions identified by upper gastrointestinal EUS.

Methods

In a prospective case series, 24 consecutive patients (14 women; median age, 68 (range, 38–84) years) with suspected malignancy underwent EUS-TNB with a 19-gauge needle. EUS was performed with a linear scanning echo endoscope. When the EUS-TNB device did not collect adequate samples, subsequent EUS-FNA was performed. The presence or absence of malignancy was confirmed by postoperative histopathology or diagnostic imaging follow-up for at least 9 months.

Results

Adequate tissue specimens were obtained in 20 of 24 (83%) patients by TNB. An accurate diagnosis was achieved in 19 of 20 (95%) patients in whom TNB was successful with a sensitivity and specificity of 93% and 100%, respectively. In 11 patients malignant disease was found, whereas 8 patients showed benign lesions on TNB-obtained histopathology. Thirteen patients underwent additional EUS-FNA. The diagnosis by TNB was confirmed in seven of nine (78%) patients with additional FNA. In three of four patients with inadequate TNB, the diagnosis was established by FNA. The overall accuracy of EUS-TNB was 79% (19/24) for all patients and 92% (22/24) with subsequent FNA. The positive and negative predictive values for the diagnosis of a malignant lesion by EUS-TNB were 57.9% and 88.9%, respectively. Neither method had any procedure-related complications.

Conclusions

EUS-guided TNB is a safe and accurate technique to obtain core specimen for histopathologic diagnosis in patients with suspected malignancies on upper gastrointestinal EUS. FNA can serve as rescue technique and should be performed if TNB fails to obtain adequate tissue samples.     

Endoscopic ultrasound with double-balloon endoscopy in the evaluation of small-bowel disease

Background

Double-balloon endoscopy (DBE) has become a new standard in enteroscopy. However, it may be difficult to make a diagnosis or plan treatment strategy with endoscopic visualization alone. The addition of endoscopic ultrasonography (EUS) has the potential to improve the ability to establish the diagnosis and develop a treatment strategy. The present study was conducted to assess the feasibility and usefulness of EUS with DBE.

Methods

EUS with DBE was performed in 31 of 891 patients who underwent DBE from July 2004 to March 2011 at Jichi Medical University Hospital. We analyzed the EUS findings for lesions and evaluated the usefulness of EUS considering the following three factors: qualitative diagnostic value for lesions, depth grading of lesions, and evaluation of the structure of severe strictures prior to endoscopic balloon dilation.

Results

EUS was performed for 31/32 lesions (97 %) in 31 patients. EUS findings were informative for 29/32 lesions (91 %). EUS findings were useful for establishing a qualitative diagnosis in 15/25 lesions (60 %). EUS findings for depth grading provided useful information for determining the therapeutic strategy in 11/13 lesions (85 %). EUS with DBE was useful in the evaluation of strictures for all six lesions (100 %). The overall usefulness of EUS with DBE on decision making was 72 % (23/32) in this study.

Conclusions

EUS with DBE is feasible and useful. It provides additional information on small-bowel disease and contributes to establishing a precise diagnosis and selection of an appropriate therapeutic strategy.     

Endoscopic ultrasonography

Endoscopic ultrasound (EUS) was introduced in the early 1980s in an attempt to improve sonographic imaging of the pancreas. Its uses have been expanded to include examination of the upper and lower gastrointestinal tracts, hepatobiliary and portal systems,and the anal sphincter; diagnosis and staging of esophageal, gastric,and pancreaticobiliary tumors; and evaluation of mediastinal nodes in lung cancer. Although EUS has its limitations and is greatly dependent on operator skill, it has wide-ranging interventional and therapeutic applications that can be expected to increase in the future with technologic advances and greater educational opportunities for physicians.     

Endoscopic Ultrasonography of the Esophagus

Endoscopic ultrasonography (EUS) is a generally accepted technique for the preoperative staging of malignant tumors in the upper and lower gastrointestinal tracts. In particular, EUS has been considered the method of choice in diagnosing esophageal carcinoma due to the relative ease in performing the examination and the accuracy of staging based on high-resolution ultrasonic imaging from within the lumen of the esophagus. This comprehensive review covers currently available EUS instruments, image characteristics of esophageal carcinoma, and images by the recently introduced miniprobe scanner. The role of the method in diagnosing superficial esophageal carcinoma and the possible treatment by endoscopic mucosal resection of this particular disease entity are discussed.     

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??Application of endoscopic ultrasound in diagnosis and therapy for biliary tract diseases JIN Zhen-dong, SUN Li-qi. Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
Corresponding author: JIN Zhen-dong,E-mail??zhendjin@126.com
Abstract Endoscopic ultrasonography (EUS) has great advantages in the diagnosis and therapy of bile duct diseases, such as microlithiasis of common bile duct, common bile duct stenosis and early lesions of gallbladder, comparing with the other traditional imaging technologies. Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is of great value in the pathologic diagnosis of biliary obstruction and hilar mass.EUS guided biliary and gallbladder drainage even cholecystolithotomy have showed promising future for clinical application.     

Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in pre-operation assess and post-operation follow-up: a prospective study of 224 cases in a single medical center

Background and aims

Diagram, diagnosis, and treatment with endoscopic submucosal dissection (ESD) for upper gastrointestinal submucosal tumors (SMTs) remain controversial, although endoscopic ultrasonography (EUS) and ESD have been established in diagnosis and treatment of SMTs in decades, respectively. In this study, we have investigated prospectively the profile of upper gastrointestinal SMTs, assessed the effect and feasibility of ESD in upper gastrointestinal SMTs treatment, as well as value of EUS in pre-ESD diagnosis and post-ESD follow-up for gastrointestinal SMTs.

Methods

The upper gastrointestinal SMTs patients detected with endoscopy were further checked by EUS, then received series ESD treatment, and fulfilled 3- and 12-month follow-up EUS detection between July 2011 and March 2015. The parameters of SMTs with EUS examination (size, original layer) and treatment with ESD (en bloc resection rate, procedure time, procedure-related complications) were investigated and analyzed.

Results

A total number of 224 patients with upper gastrointestinal SMTs were enrolled, and 108 (48.2 %) were men. The mean age was 50.4 ± 12.0 years (range 19–77 years). In total, 92 (41.1 %), 14 (6.3 %), 61 (27.2 %), 22 (9.8 %), 25 (11.2 %), and 10 (4.5 %) SMTs were located in esophagus, cardiac, fundus, body and antrum of stomach, duodenum, respectively. Two hundred and eight (92.9 %) patients were successfully treated with an en bloc ESD, while other 16 patients (7.1 %) suffered ESD failure (5.3 %, 12 case) or severe complications (1.8 %, 4 cases). The mean procedure time of ESD was 47.4 ± 27.3 min (range 10–180 min). The mean size of the SMTs measured with ESD samples was 13.6 ± 9.5 mm (range 4–113 mm). In total, 87 (38.8 %), 23 (10.3 %), and 114 (50.9 %) tumors originated from muscularis mucosa, submucosa, and muscularis propria, respectively. The majority of SMTs were leiomyoma (109, 48.7 %) and gastrointestinal stromal tumors (GIST) (77, 34.4 %), while other SMTs were confirmed as ectopic pancreas (21, 9.4 %), adenoid tumor (8, 3.6 %), lipoma (5, 2.2 %), neuroendocrine tumor (3, 1.3 %), and granulosa cell tumor (1, 0.4 %). The accuracy rate of EUS in pathological diagnosis or original layer was 82.6 % (185/224) or 74.6 % (167/224). Residual tumors were detected with EUS in 3 patients (1.3 %) in 3-month follow-up and no recurrence during 12-month follow-up period.

Conclusions

The predominant SMTs in upper gastrointestinal tract were leiomyoma in esophageal tumors which originated from muscularis mucosae and GIST in stomach which originated from muscularis propria detected satisfactorily with EUS. This study showed that ESD was a safe and effective treatment for upper gastrointestinal SMTs.