超声内镜精准评估肿瘤起源及组织学特征可提高食管平滑肌瘤的手术疗效

目的 探讨超声内镜评估肿瘤起源及组织学特征能否提高内镜下切除食管平滑肌瘤的手术疗效。 方法 回顾性分析2016年1月～2020年6月因食管黏膜下肿瘤于消化内科治疗并经病理证实为平滑肌瘤患者的临床资料。共58例食管平滑肌瘤患者接受术前超声内镜检查评估后进行内镜下切除。统计患者的肿瘤完整切除率、手术时间、住院时长及并发症发生情况。 结果 术前超声内镜提示,平滑肌瘤起源于黏膜肌层39例,固有肌层19例。瘤体平均直径1.50（0.2～6.5）cm,其中20例行内镜黏膜切除术(EMR),32例行内镜黏膜下挖除术(ESE),6例行黏膜下隧道内镜肿瘤切除术(STER)。总体完整切除率为96.6%。平均手术时间为38.29（15～100）min。术后并发症发生率15.5%（9/58）,均经保守治疗后好转。在39例黏膜肌层起源平滑肌瘤中,20例行EMR,19例行ESE,两组患者的肿瘤大小及并发症发生上差异不显著,但EMR组的手术时间及患者术后住院天数明显更短（P<0.05）。在19例固有肌层起源平滑肌瘤中,13例行ESE,6例行STER,两组患者在肿瘤大小、手术时间、术后住院天数及并发症发生上差异均无显著统计学意义。 结论 术前超声内镜精准评估肿瘤起源及组织学特征可提高食管平滑肌瘤手术疗效。     

应用内镜黏膜下剥离术处理食管黏膜病变疗效评价

目的应用内镜黏膜下剥离术(ESD)处理食管早癌及癌前病变,评价其疗效和安全性。方法回顾性分析2008年10月至2009年10月分别于复旦大学附属中山医院和新疆医科大学第六附属医院内镜检查及病理诊断为早期食管癌及癌前病变35例患者,其中男性24例,女性11例;年龄38～78岁,平均年龄60岁。对患者行内镜下治疗,观察术中出血、穿孔及术后食管狭窄的发生情况,统计病灶完整大块切除率与组织学完全切除率,通过随访评价复发或转移情况,对内镜治疗短期效果进行初步评价。结果完成ESD操作28例,7例(20.0%)改为内镜下黏膜切除术(EMR)切除,手术耗时20～125min,平均耗时65 min。颈部气肿1例,术中穿孔2例(5.7%),术中少量出血8例(22.9%),术后延迟性出血1例。组织学治愈26例(74.3%)。除2例手术治疗外,32例完成随访,1例(3.3%)失访。随访4～26个月,中位随访时间10个月。随访中,3例复发,复发率9.4%(3/32),3例发生术后食管狭窄包括1例复发病例。结论 ESD治疗早期食管癌及癌前病变具有较好的疗效和安全性。     

消化内镜黏膜下剥离术治疗早期食管癌的疗效分析

目的分析消化内镜黏膜下剥离术(ESD)治疗早期食管癌的疗效及安全性。方法纳入早期食管癌患者99例,将其中以ESD为治疗方案的52例患者纳入ESD组,同期实施内镜下黏膜切除术(EMR)的47例患者纳入EMR组,分析患者手术情况、术后情况、病灶切除效果、并发症及复发情况。结果与EMR组比较,ESD组手术时间和术后禁食时间较长,最大病灶直径较大,组间比较差异均有统计学意义(P<0.05);2组患者术后抗生素使用时间和住院时间比较,差异无统计学意义(P>0.05)。ESD组病灶整块切除率及病灶完全切除率均高于EMR组,差异有统计学意义(P<0.05)。2组患者并发症发生率比较,差异无统计学意义(P>0.05)。ESD组患者术后12个月复发率低于EMR组,差异有统计学意义(P<0.05)。结论ESD治疗直径较大的早期食管癌具有剥离病灶彻底、复发率较低的优势。     

内镜超声指导下食管黏膜下切除术的疗效研究

目的探讨在内镜超声指导下的食管黏膜下肿瘤切除术的应用。方法 2010年1月至2013年5月79例疑为上消化道黏膜下肿瘤患者进行内镜超声检查,并行内镜下黏膜下肿块切除和病理学检查,对比内镜超声检查与病理学检查结果,分析治疗效果及并发症情况。结果内镜超声检查准确提示了肿瘤所在层次,通过内镜下黏膜下肿瘤切除术切除了所有病变,术后5例发生少量出血,6例因切除黏膜较多造成食管狭窄,经处理后预后可。结论内镜超声检查能够准确判断黏膜下肿瘤,可用于指导黏膜下肿瘤切除术。     

食管间质瘤与平滑肌肿瘤对照性研究

目的 探讨食管间质瘤与平滑肌肿瘤临床病理、免疫组织化学及分子生物学特点。方法 24例食管间叶源性肿瘤用CD117、CD34等一组抗体重新进行分类,部分病例同时测定c-kit基因11外显子序列。结果 此组肿瘤分别为间质瘤3例（交界性1例、恶性2例）,年龄71、56、60岁,均为男性,瘤体直径4、8、14cm,源于固有肌层。瘤细胞梭形,上皮样多角形及印戒样,呈交叉束状、栅栏状及弥漫片状排列,免疫表型为CD117、CD34弥漫强阳性。平滑肌瘤20例,年龄30－60岁,平均41.6岁,男性12例,女性8例,15例源于固有肌层,直径0.8-10.5cm（平均4.5cm),5例源于黏膜肌层,直径为0.2-1.0cm(平均0.6cm)。平滑肌肉瘤1例,男性,61例,瘤体直径5cm,源于黏膜肌层。平滑肌（肉）瘤胞质丰富,嗜伊红,交叉束状排列,免疫表型为平滑肌肌动蛋白、肌特异性肌动蛋白、结蛋白弥漫强阳性。恶性间质瘤有c-kit基因11外显子的突变,平滑肌瘤无突变。结论 食管间叶源性肿瘤仍以平滑肌瘤多见,可发生与胃肠道间质瘤相同形态与免疫表型的间质瘤,典型平滑肌肉瘤极为罕见,食管间质瘤与平滑肌瘤具有不同的临床病理学及分子生物学特征。     

内镜黏膜下剥离术治疗胃间质瘤的远期疗效研究

目的探讨内镜黏膜下剥离术(ESD)治疗胃间质瘤的远期疗效。方法回顾性研究25例在我院行ESD治疗的胃间质瘤患者的临床资料,归纳分析其临床特征、病理结果、并发症及远期疗效。结果 25例患者均一次性完整切除病变,病变直径0.6~7.6 cm,平均3.0 cm。手术时间15~154 min,平均65 min。1例术中出血200 m L,予止血钳成功止血。4例发生术中穿孔,穿孔率16%,均采用金属钛夹成功关闭。1例切除肿瘤过大,取出时致食道黏膜机械性撕裂伤。术后住院时间为4~21 d,平均7.3 d。术后随访13~54个月,平均30个月,均未见肿瘤复发及远处转移。结论内镜黏膜下剥离术治疗胃间质瘤远期有效,可作为无远处转移的胃间质瘤的治疗方法。     

探讨金属夹在内镜黏膜下剥离术治疗胃固有肌层肿瘤穿孔的疗效

目的：探讨金属夹在内镜黏膜下剥离术治疗胃固有肌层肿瘤穿孔的疗效。方法我院从2014年2月~5月对20例胃固有肌层肿瘤穿孔的患者采用了ESD治疗方式(内镜黏膜下剥离术),现对这20例患者的治疗相关因素进行分析、归纳。结果患者肿瘤穿孔的部位位于胃底部,肿瘤穿孔后内镜手术中采用金属夹来闭合创面成功率为100%,患者的术后恢复良好。结论金属夹在内镜黏膜下剥离术中能够帮助提高内镜手术的安全性。     

128例内镜黏膜下剥离术治疗早期胃癌的护理

<正>胃癌是常见的恶性肿瘤之一,早期胃癌是指病灶不超过黏膜下层而无论有无转移的胃癌。早期胃癌的早期诊断和治疗大大提高了胃癌患者的预后[1]。随着消化内镜诊断和治疗技术的不断发展,内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)使早期胃癌病灶切除范围更加扩大,并且安全可靠,是内镜下黏膜切除术(EMR)的补充和演进,目前已成为消化道早癌及其它肿瘤的内镜下切除的新技术[2]。为了探讨ESD治疗早期胃癌的最佳护理措施,现将我院128例经ESD治疗的早     

内镜超声对上消化道黏膜下肿物的诊断价值

上消化道黏膜下肿物是常见的消化道疾病．多为良性病变．以平滑肌瘤为常见．但对于较大的黏膜下肿物（直径〉2．0cm），应注意与平滑肌肉瘤、恶性间质瘤等恶性病变相鉴别．术前明确诊断对病人治疗方法的选择和预后有重要意义。内镜超声由于可以直接在消化道内进行超声扫描．排除了肠道气体和骨骼的影响，对黏膜下肿物的大小、性质的判断具有明显优势．但其对胃肠道黏膜下恶性肿瘤的诊断尚缺乏统一标准，笔者通过回顾性研究．将术前内镜超声检查（EUS）结果与术后病理组织检查结果相比较．进一步明确EUS对较大黏膜下肿物良恶性判断的临床意义。     

超声内镜指导下消化道间质瘤诊断及治疗

目的评价超声内镜对消化道间质瘤的诊断及治疗的指导意义。方法常规胃镜及结肠镜检查发现消化道隆起性病变并行超声内镜检查诊断为间质瘤患者92例,其中男性44例,女性48例;年龄18～71岁,平均年龄44岁。根据术前超声内镜检查显示起源层次及大小,分别采取内镜下治疗、手术治疗及随访。结果超声内镜诊断间质瘤共92例,食管39例,胃44例,十二指肠5例,结肠4例。发生于黏膜肌层47例,发生于固有肌层45例。内镜下治疗26例,其中高频电凝电切术6例,内镜下套扎术12例,内镜下黏膜切除术8例,内镜治疗术后出血1例,经内镜下保守治疗止血成功。外科手术治疗8例。内镜下治疗中14例病理检查均为良性间质瘤,手术治疗中3例为交界性间质瘤,5例为良性间质瘤。结论超声内镜对消化道间质瘤定性诊断有较高的特异度及灵敏度,使对消化道间质瘤内镜下治疗成为更快速、损伤更小、更为安全的治疗手段。     

The diagnostic value of endoprobe for small esophageal leiomyomas derived from the muscularis mucosae

Esophageal leiomyoma derived from the muscularis mucosae (MM) is a rare condition, and the optimal modality for diagnosis and treatment is controversial. Endoscopic ultrasonography can provide an accurate image of esophageal layer structure, providing information on lesion suitability for potential endoscopic therapy. We attempted to investigate the diagnostic value of a transendoscopic balloon-tipped miniature ultrasonic endoprobe for small esophageal leiomyomas derived from MM. We resected 7 small esophageal leiomyomas derived from MM by endoscopic mucosal resection (EMR), all of which were diagnosed by a balloon-tipped endoprobe. The endosonographic and pathologic features of 7 cases of small esophageal leiomyomas derived from MM were compared. The balloon-tipped endoprobe clearly showed all 7 small esophageal leiomyomas derived from MM, even those under 5 mm in size (smallest lesion, 3.0 mm). The endosonographic characteristics of small esophageal leiomyomas derived from MM were a hypoechoic mass with smooth, regular, and a well-defined outer margin and homogenous inner echogram arising from the second hypoechoic layer. Complete resections were possible in all 7 cases by EMR without any complications. Tumor size was 3.0-13.5 mm (mean 7.8 mm) in maximum diameter. In all cases, endosonographic findings by endoprobe were exactly concordant with pathologic finding in determining the tumors depth in the esophageal wall, tissue origin and characteristics, growth pattern, and size. We detail the balloon-tipped endoprobe is a simple, convenient, and very useful in making accurate diagnosis of small esophageal leiomyomas derived from the MM and the appropriate applications of EMR.     

Poly(lactic acid-co-glycolic acid)–poly(ethylene glycol)–poly(lactic acid-co-glycolic acid) thermogel as a novel submucosal cushion for endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is a clinical therapy for early stage neoplastic lesions in the gastrointestinal tract. It is, however, faced with a crucial problem: the high occurrence of perforation. The formation of a submucosal fluid cushion (SFC) via a fluid injection is the best way to avoid perforation, and thus an appropriate biomaterial is vital for this minimally invasive endoscopic technique. In this study, we introduced an injectable thermogel as a novel submucosal injection substance in ESD. The hydrogel synthesized by us was composed of poly(lactic acid-co-glycolic acid)–poly(ethylene glycol)–poly(lactic acid-co-glycolic acid) (PLGA–PEG–PLGA) triblock copolymers. The polymer/water system was a low-viscosity fluid at room temperature and thus easily injected, and turned into a non-flowing gel at body temperature after injection. The submucosal injection of the thermogel to create SFCs was performed in both resected porcine stomachs and living minipigs. High mucosal elevation with a clear margin was maintained for a long duration. Accurate en bloc resection was achieved with the assistance of the thermogel. The mean procedure time was strikingly reduced. Meanwhile, no obvious bleeding, perforation and tissue damage were observed. The application of the thermogel not only facilitated the ESD procedure, but also increased the efficacy and safety of ESD. Therefore, the PLGA–PEG–PLGA thermogel provides an excellent submucosal injection system, and has great potential to improve the ESD technique significantly.     

Efficacy and Safety of Endoscopic Resection Therapies for Rectal Carcinoid Tumors: A Meta-Analysis

Purpose

Several endoscopic resection therapies have been applied for the treatment of rectal carcinoid tumors. However, there is currently no consensus regarding the optimal strategy. We performed a meta-analysis to compare the efficacy and safety of endoscopic mucosal resection (EMR) or modified EMR (m-EMR) versus endoscopic submucosal dissection (ESD) for the treatment of rectal carcinoid tumors.

Materials and Methods

PubMed, Web of Science, Medline, Embase and CNKI were searched up to the end of January 2014 in order to identify all studies on the effects of EMR (or m-EMR) and ESD on rectal carcinoid tumors.

Results

A total of fourteen studies involving 782 patients were included. The pooled data suggested a significantly higher rate of pathological complete resection among patients treated with ESD or m-EMR than those treated with EMR [odds ratio (OR)=0.42, 95% confidence interval (CI): 0.25-0.71; OR=0.10, 95% CI: 0.03-0.33, respectively], while there was no significant difference between the m-EMR group and ESD group (OR=1.19, 95% CI: 0.49-2.86); The procedure time of ESD was longer than EMR or m-EMR groups [mean differences (MD)=-11.29, 95% CI: -14.19 - -8.38, MD= -10.90, 95% CI: -18.69 - -3.11, respectively], but it was insignificance between the EMR and m-EMR groups. No significant differences were detected among the treatment groups with regard to complications or recurrence.

Conclusion

The results of this meta-analysis suggest that treatment of rectal carcinoid tumors with ESD or m-EMR is superior to EMR, and the efficacy of m-EMR is equivalence to ESD treatment. However, more well-designed studies are needed to confirm these findings.     

Bronchogenic cyst in the hepatogastric ligament masquerading as an esophageal mesenchymal tumor: a case report

Lesions occur in hepatogastric gap is common, but most of these lesions are from stomach, lower esophagus and pancreas lesions extending or transferring to the gap. Lesions occurred in the hepatogastric ligament are rare, especially bronchogenic cysts in the hepatogastric ligament. So far, there were no relevant cases reported. Here, we report a case of bronchogenic cyst in the hepatogastric ligament that masquerading as an esophageal mesenchymal tumor. A 24-year-old young man presented with abdominal bloating was diagnosed as esophageal mesenchymal tumor in previous hospital by gastroscopy, endoscopic ultrasonography (EUS) and computed tomography (CT) examination. For the sake of endoscopic submucosal dissection (ESD), the man was transferred to our hospital. During surgery, we found no lesions in lower esophagus, but external pressure ridge lesions in the distal esophagus right side wall. Then laparoscopic surgery and pathology confirmed as bronchogenic cyst in the hepatogastric ligament. We report what is, to the best of our knowledge, the first case of a bronchogenic cyst in the hepatogastric ligament masquerading as an esophageal mesenchymal tumor.     

A case of primary esophageal B-cell lymphoma of MALT type,presenting as a submucosal tumor

The primary esophageal lymphoma is extremely rare, and shows various morphologic characteristics. Only a single case of mucosa-associated lymphoid tissue (MALT) type lymphoma confined to the esophagus has been reported in the literature. A 61-yr-old man was referred to our hospital for evaluation of an esophageal submucosal tumor (SMT) that had been detected incidentally by endoscopy. He had a history of pulmonary tuberculosis with long-term anti-tuberculosis medication 15 yr before, and also had a history of syphilis, which had been treated one year before. He had been taking a synthetic thyroid hormones for the past 10 months because of an autoimmune thyroiditis. Endoscopy showed a longitudinal round and tubular shaped smooth elevated lesion, which was covered with intact mucosa and located at the mid to distal esophagus, 31 cm to 39 cm from the incisor teeth. Endoscopic ultrasonography (EUS) showed a huge longitudinal growing intermediate- to hypo-echoic mass located in the submucosal layer with internal small, various sized honeycomb-like anechoic lesions suggesting germinal centers. Subsequently, he underwent a surgery, which confirmed the mass as a primary esophageal low-grade B-cell lymphoma of MALT type.     

Endoscopic ultrasonography‐guided fine‐needle aspiration for diagnosing upper gastrointestinal submucosal lesions: A prospective study of 50 cases

The objective was to assess EUS‐FNA for diagnosing intramural upper GI tract lesions. The subjects were 50 patients (21M/29F) with upper GI submucosal lesions who underwent EUS‐FNA at a referral center for GI system over a 12‐month period. All cases were followed for 1 year after initial EUS‐FNA. Cytologic diagnoses were categorized as benign, malignant, suspicious for malignancy, mesenchymal tumor, endocrine tumor, or nondiagnostic. All tumors were assessed for various cytomorphologic features. The accuracy of the initial FNA diagnoses was evaluated for each patient who also underwent subsequent histopathological examination of a core biopsy and/or surgical biopsy/resection material of the same lesion. According to the site of the lesions; while 84% of all esophageal lesions were diagnosed as mesenchymal; 67% of all gastric lesions were mesenchymal. The sole lesion was nonmesenchymal (benign cyst) in duodenum. The sensitivity, specificity, positive and negative predictive values, and accuracy of EUS‐FNA for diagnosing submucosal mesenchymal tumors of the upper GI tract were 82.9, 73.3, 87.9, 64.7, and 80%, respectively. The corresponding values for nonmesenchymal lesions were 100, 85.7, 80, 100, and 90.9%. Our experience confirms that EUS‐FNA is an extremely valuable tool for diagnosing submucosal lesions of the upper GI, and is particularly useful in cases where endoscopic forceps biopsy does not lead to diagnosis. Optimal results can be yielded by a close working relationship between the gastroenterologist and pathologist. Diagn. Cytopathol. 2011. © 2010 Wiley‐Liss, Inc.