内镜超声检查术对十二指肠隆起性病变的诊治价值

内镜超声检查术（endoscopic ultrasonograghy，EUS）的临床应用使我们对消化道疾病的诊断水平和质量大大提高。我们采用微型超声探头对169例常规胃镜拟诊为十二指肠隆起性病变患者进行了EUS检查，探讨EUS对十二指肠隆起性病变的诊治价值。[第一段]     

超声内镜对2886例上消化道隆起性病变诊断和治疗价值分析

目的探讨上消化道病变超声内镜检查与治疗的临床价值。方法收集解放军大连210医院1999年1月-2014年2月2 886例上消化道病变患者,采用FUJNON SP-701型小探头超声内镜(频率为12 MHz、15 MHz),纵轴电子线阵扇扫,记录病灶超声内镜(endoscopic ultrasonography,EUS)检查的声像学特征。结果病变部位:食管1 194例,贲门116例,胃1 376例,十二指肠200例。病变种类:包括平滑肌瘤、恶性间质瘤、息肉、囊肿、脂肪瘤、异位胰腺、血管瘤、肿瘤和外压性病变,EUS依据不同回声和起源予以诊断。结论 EUS是诊断上消化道隆起性病变的首选方法,对内镜下治疗隆起性病变具有指导意义,值得临床推广。     

胃镜联合微超声探头对上消化道黏膜隆起病变的诊断价值

目的评价超声微探头对上消化道腔内隆起性病变的诊断价值。方法对44例电子胃镜或胃肠造影等检查示上消化道腔内隆起性病变患者进行超声微探头检查。结果 56.8%（25/44）黏膜隆起性病变位于胃壁,38.6%（17/44）位于食管壁,4.6%（2/44）位于十二指肠。微超声探头对44例病变均可显示,确诊率97.7%,联合胃镜确诊率100%。结论微超声探头有助于上消化道黏膜隆起性病变的定位及定性诊断。     

内镜超声对消化道黏膜下隆起性病变的应用价值

目的探讨内镜超声(endoscopic ultrasonography,EUS)在消化道黏膜下隆起性病变中的应用价值。方法回顾性分析选取2018年1月至2020年10月徐州医科大学附属徐州市立医院内镜中心EUS初诊消化道黏膜下隆起性病变并同时获取病理结果的患者117例,通过EUS与病理结果比对,探讨EUS对消化道黏膜下隆起病变的应用价值。结果入组研究患者117例,EUS初诊平滑肌瘤37例、间质瘤32例、神经内分泌肿瘤17例、脂肪瘤9例、异位胰腺10例、十二指肠布氏腺(Brunner)腺瘤3例、胃体淋巴瘤1例、十二指肠血管瘤1例,胃壁外病变外压7例。EUS检查结果显示消化道黏膜下隆起性病变以平滑肌瘤及间质瘤居多,表现为起源于黏膜肌层或固有肌层的低回声病变;所有病变均通过活检、内镜微创手术或外科手术获取病理标本。最终EUS和病理诊断符合率为107/117(91.5%),其中10例病例误诊。结论EUS虽对消化道黏膜下隆起性病变存在一定的误诊,但结合病变声像学特点(回声、起源、大小及有无邻近组织浸润等),仍能很好地评判隆起灶病变性质,规范临床诊疗。     

老年上消化道隆起性病变电子内镜超声诊断与病理切片结果的差异分析

目的探讨电子内镜超声在老年上消化道隆起性病变诊断中的临床价值。方法老年上消化道隆起性病变患者98例,均进行超声内镜检查,比较超声内镜诊断准确率。结果 98例老年上消化道隆起性病变患者中,经超声内镜检查,按病变部位:胃65例(66.63%)、食管23例(23.47%)、十二指肠10例(10.20%);按病变范围:病灶直径1.0 cm 24例(24.49%)、1.0~2.0 cm者53例(54.08%)、2.0 cm者21例(21.43%);按病变类型:间质细胞瘤31例(31.62%)、平滑肌瘤23例(23.47%)、息肉22例(22.45%)、脂肪瘤10例(10.20%)、异位胰腺7例(7.14%)、囊肿3例(3.06%)、隆起糜烂性炎症2例(2.04%);与手术病理比较,超声内镜诊断准确为91.84%。结论经超声内镜检查,有助于判断老年上消化道隆起性病变的病灶分层及性质,可为临床治疗方式的选择提供可靠依据。     

超声内镜、电子胃镜及CT检查对上消化道黏膜下隆起型病变的诊断价值

目的探讨超声内镜(EUS)、电子胃镜及计算机断层扫描(CT)检查对上消化道黏膜下隆起型病变的诊断价值。方法回顾性分析2016年1月至2018年12月在我院行电子胃镜、EUS检查和CT检查并最终经手术病理活检明确诊断的上消化道黏膜下隆起型病变患者84例,以术后病理为金标准,对EUS、电子胃镜或CT诊断的准确度进行统计分析。结果 84例患者中,以平滑肌瘤及胃间质瘤较为常见,分别占45. 24%、34. 52%。EUS诊断上消化道黏膜下隆起型病变与术后病理的符合率78. 57%;电子胃镜诊断结果与术后病理的符合率42. 86%; CT诊断结果与术后病理的符合率46. 43%。EUS诊断符合率显著高于电子胃镜(P 0. 001)。EUS诊断符合率显著高于CT(P 0. 001)。结论 EUS能够提供病变起源、大小、边界、回声等特征,对于上消化道黏膜下隆起型病变诊断有较高价值,优于电子胃镜或CT。     

超声内镜对食管黏膜下隆起性病变的诊治价值

对于食管黏膜隆起性病变,内镜超声检查（endoscopic uhrasonography,EUS）既可观察病变表面黏膜的形态,又能获得黏膜下病变的起源、大小、边界、可能的性质及与邻近脏器关系等信息,对黏膜下隆起性病变的诊断和鉴别诊断具有重要的临床应用价值,同时,为选择不同的治疗手段提供依据。现回顾本院86例食管黏膜下隆起性病变超声内镜检查和选择相应治疗的情况,旨在探讨超声内镜在食管黏膜下隆起性病变诊治中的价值。     

内镜黏膜下剥离术前内镜超声标准超声探头检查避免微探头对食管胃间质瘤大小的误判

背景:上消化道间质瘤行内镜黏膜下剥离术(ESD)治疗前常规行内镜超声检查(EUS)时如使用微探头(频率12、15、20 MHz),常出现术中病灶大小、深度与术前判断不符的情况,从而增加手术难度甚至导致穿孔、大出血等并发症。目的:探讨ESD术前标准超声探头(频率5、7.5 MHz)EUS检查判断上消化道间质瘤大小的临床价值。方法:收集武汉大学人民医院2012年1月—2014年10月所有经胃镜和EUS检查初步疑诊食管胃间质瘤患者的临床资料,对其中195例接受ESD治疗者进行回顾性分析。结果:195例接受ESD治疗者中145例术后病理证实为间质瘤,其中由标准探头EUS诊断者37例,微探头EUS诊断者108例,14例患者因ESD治疗失败而转外科治疗。ESD治疗失败者中,原因为标准探头EUS误判病灶起源者1例,微探头EUS误判病灶大小者9例,标准探头误判率低于微探头,但差异无统计学意义(2.7%对8.3%,P0.05)。9例微探头误判病例显示的病灶大小与实际严重不符[(1.22±0.51)cm对(3.97±1.06)cm,P0.01]。另有3例患者因标准探头EUS准确判断病灶结构层次或血流而避免或及时终止ESD。结论:对于拟行ESD治疗的上消化道间质瘤患者,术前选择行标准探头EUS检查能更准确地了解病灶大小、起源和血流情况,从而降低手术风险,提高治疗成功率。     

内镜超声检查术对十二指肠囊肿的诊断价值

目的 研究内镜超声检查术(EUS)对十二指肠囊肿的诊断价值.方法 分析十二指肠囊肿患者的临床表现,普通胃镜、EUS的结果和随访结果,研究总结该病的超声影像学特征.结果 105例十二指肠囊肿患者均无与病灶相关的症状,该病在超声内镜下具有特征性的影像学改变,即黏膜下病灶位于肠壁内,探头触压病灶易变形,内呈无回声状,边界清楚,源于黏膜下层,后方有回声增强效应,周围肠壁层次结构正常.EUS可明确病灶的起源、大小和性质并与其他黏膜下病变相鉴别.术后随访5年病灶无明显变化.结论 十二指肠囊肿属良性疾病,EUS对该病的诊断具有较好的临床价值.     

内镜超声检查术对十二指肠囊肿的诊断价值

目的 研究内镜超声检查术(EUS)对十二指肠囊肿的诊断价值.方法 分析十二指肠囊肿患者的临床表现,普通胃镜、EUS的结果和随访结果,研究总结该病的超声影像学特征.结果 105例十二指肠囊肿患者均无与病灶相关的症状,该病在超声内镜下具有特征性的影像学改变,即黏膜下病灶位于肠壁内,探头触压病灶易变形,内呈无回声状,边界清楚,源于黏膜下层,后方有回声增强效应,周围肠壁层次结构正常.EUS可明确病灶的起源、大小和性质并与其他黏膜下病变相鉴别.术后随访5年病灶无明显变化.结论 十二指肠囊肿属良性疾病,EUS对该病的诊断具有较好的临床价值.     

超声内镜对上消化道黏膜下小病变的诊断价值

目的探讨超声内镜对上消化道直径〈3cm的黏膜下病变的诊断价值。方法回顾性分析2002年1月～2010年8月我院收治的上消化道直径〈3em的黏膜下小病变患者的临床资料。纳入标准：患者经黏膜下肿块剜出术切除病灶,手术后有确切病理诊断;患者在术前曾行超声内镜检查。结果共纳入54例患者,病灶平均大小为（1．06±0．58）cm。黏膜下肿块剜出术的治愈率达82．9％。超声内镜对此类病灶的诊断准确率为74．1％（40／54）;共有14例病例误诊,其中异位胰腺最常见。结论超声内镜对上消化道直径〈3cm的黏膜下病灶具有较高的诊断价值,异位胰腺是最易误诊的病变,黏膜下肿块剜出术可能是治疗上消化道黏膜下小病变的一种有效且安全的方法。     

十二指肠副乳头的超声内镜诊断

目的探讨内镜超声检查术(EUS)对十二指肠副乳头的诊断价值。方法对我院内镜中心2006年2月28日至2018年2月28日期间通过EUS检查诊断为十二指肠副乳头的122例病例进行分析总结。结果122例十二指肠副乳头病例年龄(52.1±12.9)岁,男性多于女性。副乳头以十二指肠降部乳头上方最多见(88/122,72.13%),其次位于球降交界(29/122,23.77%),少部分位于球部(5/122,4.10%)。副乳头均为单发,大多数直径在0.5~1.0 cm(88/122,72.13%),少部分直径大于1.0 cm(23/122,18.85%),也有部分直径小于0.5 cm(11/122,9.02%)。EUS下多为低回声(71/122,58.20%)或中低回声影(35/122,28.68%),回声多均匀。黏膜层光整,黏膜下层及以下表现为括约肌样结构,边界大部分清楚(121/122,99.18%),多数副乳头中央常可见特征性的裂隙样管腔结构(83/122,68.03%),周边肠壁层次结构正常,肠周无相关肿大淋巴结。结论EUS能清晰显示十二指肠副乳头及相邻器官结构,对十二指肠副乳头诊断具有较高的应用价值。     

EUS mini probes in diagnosis of cystic dystrophy of duodenal wall in heterotopic pancreas： A case report

Cystic dystrophy of the duodenal wall is a rare condition characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall. A 38-year-old man was admitted to the hospital for abdominal pain and vomiting after food intake. The diagnosis of acute pancreatitis was initially suspected. Abdominal ultrasound examination revealed thickening of the second portion of duodenal wall within which, small cysts (diameter, less than 1 cm) were present in the vicinity of pancreatic head.The head of pancreas appeared enlarged (63 mm×42 mm)and hypoechoic. Upper endoscopy and barium X-ray series were performed revealing a severe circumferential deformation, as well as 4 cm long stenosis of the second portion of the duodenum. CT examination revealed multiple cysts located in an enlarged, thickened duodenal wall with moderate to strong post-contrast enhancement. We suspected that patient had cystic dystrophy of duodenal wall developed in the heterotopic pancreas and diagnosis was confirmed by endoscopic ultrasound (EUS). Endoscopi cutrasound (EUS) revealed drcular stenosis from the duodenal bulb onwards. A twenty megaHertz mini-probe examination further showed diffuse (intramural) infiltration of duodenal wall limited to the submucosa and muscularis propria of the second portion of duodenum with multiple microcysts within the thickened mucosa and submucosa, a. Patient was successfully surgically treated and pancreatoduodenectomy was performed. The pathological examination confirmed a diagnosis of cystic dystrophy of a heterotopic pancreas.Endoscopic ultrasonography features allow preoperative diagnosis of cystic dystrophy of a heterotopic pancreas in duodenal wall, with inb‘alumina120 MHz mini probe sonography being more efficient in cases of luminal stenosis.     

Utility of endoscopic ultrasound for the diagnosis and treatment of submucosal tumors of the upper gastrointestinal tract

'Submucosal tumors' represent a bulge underneath the mucosa of the gastrointestinal tract whose etiology cannot be determined by gastrointestinal endoscopy or barium studies. Because many of these lesions do not arise from the submucosa, these abnormalities have been recently referred to as subepithelial lesions. The aim of this review was to assess the value of EUS for the diagnosis and management of suspected subepithelial lesions. Endoscopic ultrasound (EUS) is currently considered the investigative procedure of choice when a subepithelial lesion has been detected. EUS can determine the intra- or extramural location of the lesion, can differentiate vascular, cystic and solid lesions, and can characterize the layer(s) of origin or ultrasound characteristics (size, borders, homogeneity, anechoic areas or echogenic foci). EUS cannot differentiate exactly between benign and malignant tumors, but it can guide fine needle aspiration (FNA) biopsy or histologic needle biopsies, thus providing samples for cytology or histological analysis. EUS also offers valuable information on the clinical management, and helps to decide whether a lesion should be consequently followed, removed by endoscopy or by surgery. The introduction of EUS and endoscopic submucosal resection (ESMR) clearly changed the management of small subepithelial lesions (less than 3 cm). A clinical decision algorithm was subsequently developed, taking into consideration the information offered by most of the reviews and case reports. However, further prospective studies will have to establish the value and indications of ESMR (used in association with EUS), for the treatment of subepithelial lesions, as compared to surgery and follow-up.     

Diagnostic accuracy in peripheral lung lesions. Factors predicting success with flexible fiberoptic bronchoscopy.

Ninety-seven consecutive peripheral lung lesions were evaluated by biplane fluoroscopically guided flexible fiberoptic bronchoscopy and analyzed to define features that predict diagnostic yield. The overall diagnostic accuracy was 56 percent (63 percent for malignant and 38 percent for benign lesions). The most important characteristic associated with a positive cyto- or histopathologic diagnosis was size of the lesion; the yield was 28 percent when the diameter was less than 2.0 cm compared to 64 percent if the diameter was greater than or equal to 2.0 cm (P = 0.0035). The diagnostic yield was similar for lesions located in the outer and middle third of the lung if the diameter was greater than 2.0 cm; inner one-third lesions were correctly diagnosed more frequently, related in part to the larger size of these lesions. There was no significant difference in diagnostic yield for the following: segmental location, greatest distance from carcina on either the posteroanterior or lateral radiograph, or radiographic characteristics of the lesion. We conclude that biplane fluoroscopically guided flexible fiberoptic bronchoscopy is a reasonable diagnostic procedure for peripheral lesions greater than or equal to 2.0 cm in diameter, but that alternative procedures should be used for lesions under 2.0 cm in diameter.     

Endoscopic ultrasonography in diagnosis and staging of pancreatic cancer

The accuracy of endoscopic ultrasonography (EUS) for diagnosis of pancreatic cancers was evaluated in consecutive 232 patients with possible pancreatic cancer, and that for assessment of their locoregional spread was evaluated in 28 patients with pancreatic cancer subjected to pancreatectomy, in comparison with the accuracies of transabdominal ultrasonography (US) and computed tomography (CT). EUS was found to be significantly more accurate than US or CT and was especially useful for detecting small pancreatic cancers of less than 2 cm in diameter. With EUS, pancreatic cancers could be detected as a hypoechoic mass with a relatively unclear margin and irregular internal echoes. EUS was also more sensitive than CT and US for detecting venous and gastric invasions: it was more useful for detecting direct invasion of pancreatic cancers when the tumors were less than 3 cm in diameter. These findings indicate that EUS is an accurate method for diagnosis of pancreatic cancer and assessment of their locoregional spread and is particularly useful for detecting small tumors.     

Prospective endoscopic ultrasonographic evaluation of the frequency of nonfunctioning pancreaticoduodenal endocrine tumors in patients with multiple endocrine neoplasia type 1

BACKGROUND: The frequency of pancreaticoduodenal endocrine tumors in patients with multiple endocrine neoplasia type 1 (MEN1) remains unknown. AIM: To evaluate prospectively with endoscopic ultrasonography (EUS) the frequency of nonfunctioning (asymptomatic) pancreaticoduodenal tumors. PATIENTS AND METHODS: MEN1 patients without functioning pancreatic involvement underwent systematic pancreaticoduodenal EUS in nine GTE (Groupe des Tumeurs Endocrines) centers. Demographic and clinical factors predictive of pancreatic involvement were sought, and standardized biochemical measurements obtained. RESULTS: Between November 1997 and July 2004, 51 patients (median age: 39 [range: 16-71] yr) were studied. MEN1 had been diagnosed 3 [0-20] yr earlier, notably by genetic screening for 26 (51%) with asymptomatic disease. Twenty-five patients had minor biochemical anomalies (<2 x normal (N)) and serum somatostatin was 10.8 N in 1; EUS detected pancreatic lesions in 28 patients (54.9%; 95% CI: 41.3-68.7%). A median of three [1-9] tumors with a median diameter of 6 [2-60] mm was found per patient; for 19 (37.3%) patients a tumor measured > or =10 mm and > or = 20 mm in 7 (13.7%) patients. Only one duodenal lesion was found and three patients had peripancreatic adenopathies. Pancreatic tumors were not associated with any of the studied parameters, notably age, family history, biochemical anomalies. Sixteen of twenty-six patients underwent EUS monitoring over 50 [12-70] months; six (37.5%) had more and/or larger pancreatic lesions. CONCLUSION: The frequency of nonfunctioning pancreatic endocrine tumors is higher (54.9%) than previously thought. The size and number of these tumors can increase over time. Pancreatic EUS should be performed once MEN1 is diagnosed to monitor disease progression.     

Endoscopic ultrasound-guided fine-needle aspiration of lesions near the aortoiliac bifurcation via an upper gastrointestinal approach

Background and Aims: Endoscopic ultrasound (EUS)‐guided fine‐needle aspiration (FNA) is widely used to investigate posterior mediastinal and upper abdominal lesions. Previously, we noticed that the aortoiliac bifurcation can be visualized by transduodenal EUS scanning, and the surrounding area might be a potential target for EUS‐guided FNA. This study aimed to determine the feasibility of using EUS‐guided FNA to study lesions near the aortoiliac bifurcation via the upper gastrointestinal approach. Methods: This study was a prospective pilot study of consecutive patients with a lesion of unknown origin near the aortoiliac bifurcation. Results: EUS‐guided FNA was used in six patients. The aortoiliac bifurcation was visible from the inferior duodenal angle in all patients; however, the lesions could be visualized in only five patients (3 via the transduodenal approach, and 2 via the transgastric approach). In one patient with a lesion on the left side, the lesion could not be visualized by either the transgastric or transduodenal approach. In the other five patients, EUS‐guided FNA was successful, and FNA specimens were adequate for histopathological assessment. The diagnoses were lymphoma (n = 3), plasmacytoma (n = 1), and neurinoma (n = 1). All lymphoma cases were subclassified as diffuse large B‐cell lymphoma (n = 2) or grade 2 follicular lymphoma (n = 1). No complications were observed. Conclusions: The aortoiliac bifurcation was visible in all patients by transduodenal EUS scanning. FNA of the legions near the aortoiliac bifurcation was possible in five of six patients by using either the transgastric or transduodenal approach.     

Endoscopic ultrasound-guided treatment of bleeding duodenal varix

A 35-year-old man presented with recurrence of upper gastrointestinal bleed after eradication of esophageal varices. Upper gastrointestinal endoscopy revealed submucosal lesion in the duodenum and endoscopic ultrasound (EUS) demonstrated it to be a duodenal varix. Cyanoacrylate glue was injected into the duodenal varix and successful obliteration of the duodenal varix was demonstrated on a follow up EUS.     

Pancreatic carcinomas smaller than 3.0 cm: endosonography (EUS) in diagnosis, staging and prediction of resectability

BackgroundThe size of a pancreatic carcinoma determines prognosis and resection. The aim of this study was to review our clinical experience with endoscopic ultrasound (EUS) in diagnosing and staging pancreatic tumours <3.0 in diameter.MethodsFrom February 1997 to October 2000 medical records and results of abdominal ultrasound (US), spiral computed tomography (CT) and EUS with fine-needle aspiration biopsy (FNA) were reviewed in 17 patients operated for histologically proven pancreatic adenocarcinoma measuring ≤ 3.0 cm in diameter. The mean age of the patients was 64 years (range 42–76 years).ResultsUS identified a pancreatic lesion in 11/17 (65%) patients. Spiral CT showed a total of 16/17 (94%) patients with a lesion. EUS identified pancreatic tumour in all patients (100%), and tissue was obtained from 15/17 patients (88%). Mean tumour size was 2.5 cm (range 0.8–3.0 cm). EUS accuracy in evaluating the portal vessels was 78%, superior mesenteric artery 100%, tumour stage (T) 88%, isolated node stage (N) 65% and combined TN staging was 53%. Regarding resectability, EUS sensitivity was 88%, specificity 89%, negative predictive value 89%, positive predictive value 88% and accuracy 88%. Besides cytological material, EUS-FNA histological diagnosis was possible in 12/17 patients (71%). There was only one case of mild post-procedure acute pancreatitis.ConclusionEUS-FNA is safe and has high diagnostic (100%) and local staging (88%) accuracy in pancreatic cancers <3.0 cm in diameter.