胃异位胰腺的内镜诊治

目的探讨胃异位胰腺胃镜和超声内镜的表现及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)对胃异位胰腺的疗效与安全性。方法经胃镜及超声内镜诊断为胃异位胰腺患者17例,总结其临床症状、胃镜和超声内镜下表现,将有临床症状的16例患者行ESD治疗,另1例患者随访观察。结果胃镜下多表现为隆起性病变,顶部可见导管开口呈脐样凹陷;14例患者行超声内镜检查,病灶以累及黏膜下层为主,可累及固有肌层,多数为低回声、等回声或混合回声改变;16例患者接受ESD治疗,术中发现2例患者累及固有肌层,术中、术后无出血、穿孔等并发症。术后病检提示累及固有肌层3例,随访发现1例患者病灶存在,1例未行手术患者病灶无明显变化。结论胃镜及超声内镜检查是诊断胃异位胰腺及指导治疗的重要手段。ESD可安全、有效地应用于胃异位胰腺的治疗,并发症发生率低,无症状患者可随访观察。     

超声内镜对胃异位胰腺的诊断及治疗价值

目的 探讨超声内镜(EUS)对胃异位胰腺的诊断及治疗价值.方法 收集本院2009年3月至2011年8月经普通胃镜及超声内镜检出的32例胃异位胰腺患者,分析异位胰腺的EUS图像特征,对其行内镜下皮圈套扎联合高频电切除术,评价其疗效.结果 胃异位胰腺在EUS下表现为隆起型病变,可发生于胃壁超声结构任何一层或多层,以黏膜下层多见,呈低、中或混合回声.其中22例行皮圈套扎后高频电切除,无明显并发症,17例内镜复查无复发.2例行内镜下黏膜切除术(EMR),1例行黏膜剥离术(ESD),7例未予处理.结论 EUS对异位胰腺有重要的诊断价值,内镜下皮圈套扎后高频电切除治疗简单、经济、安全、有效,值得临床推广.     

食管黏膜下肿物的特性以及超声内镜的诊断和治疗意义

背景：食管病变内镜下或手术治疗的风险均较高,术前准确判断病变的层次和性质,对决定手术的方式十分重要。目的：探讨食管黏膜下肿物的特性以及超声内镜对食管黏膜下肿物的诊断、治疗意义。方法：由内镜检查发现的116例食管黏膜下肿物患者行超声内镜检查,并给予相应的切除治疗,总结超声内镜下食管黏膜下肿物的特性。结果：超声内镜下88例（75．9％）食管黏膜下肿物的直径〈1cm,104例（89．7％）病变起源于黏膜肌层,多数（85．3％）表现为低回声或混合偏低回声的声像图。80例接受切除治疗,其中67例（83．8％）行EMR治疗,肿物直径〈1cm者占89．6％,局限于黏膜肌层占97．0％。组织病理学分析表明食管黏膜下肿物以平滑肌瘤最为常见（86．3％）。超声内镜诊断与病理诊断的符合率约为82％。结论：大多数食管黏膜肌层起源的肿物行EMR治疗简便、安全,对于较大的病灶,或起源于固有肌层者ESD仍是一种安全有效的方法。超声内镜可判断食管黏膜下肿物起源并进行定性诊断,从而指导临床合理选择黏膜下肿物的治疗方法。     

胃肠神经内分泌肿瘤内镜表现及内镜下治疗效果分析

目的 探讨胃肠神经内分泌肿瘤的超声内镜表现及内镜下治疗效果。 方法 纳入在西安交通大学第一附属医院行内镜下治疗的27例胃肠神经内分泌肿瘤患者资料，回顾性分析其临床特征、超声内镜表现、病理特征及内镜下治疗效果。 结果 27例患者的病变内镜下表现为黏膜下隆起，超声内镜检查示病变长径（0.69±0.44）cm（0.32~2.00 cm），来源于黏膜下层14例（51.9%）、黏膜肌层8例（29.6%）、黏膜层5例（18.5%），诊断准确率92.0%。行内镜黏膜切除术（endoscopic mucosal resection,EMR）6例，内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）21例，ESD术后出血发生率4.8%。术后病理为G1级20例（74.1%），G2级6例（22.2%），G3级伴淋巴管癌栓1例（3.7%）。术后随访3~36个月总生存率96.3%，对于局限于黏膜下层以内、无脉管浸润的G1、G2级神经内分泌瘤患者，EMR术后复发率较ESD高（33.3%比0，P=0.042）；EMR与ESD术后出血、穿孔并发症及患者生存率差异无统计学意义。 结论 超声内镜可用于胃肠神经内分泌肿瘤的术前诊断，对2 cm以内、黏膜下层以内、无脉管浸润的G1、G2级胃肠神经内分泌瘤ESD治疗复发率低于EMR。     

内镜超声检查术对上消化道异位胰腺的诊治价值

目的探讨超声内镜对上消化道异位胰腺的诊治价值。方法总结近年来于消化内镜中心经超声内镜诊断为异位胰腺并行病理检查的52例患者的临床资料,回顾性分析其图像特征及诊断准确率。结果52例内镜超声诊断的异位胰腺者中41例患者经病理证实为异位胰腺,超声内镜诊断符合率为78．85％（41／52）,其余6例为间质瘤,4例为平滑肌瘤,1例为神经鞘瘤。超声内镜下上消化道异位胰腺均表现为隆起性病变,病变位于胃窦37例,十二指肠2例,胃体1例,胃底1例;表现为高回声1例,中等回声10例,低回声18例,混杂回声12例;累及至黏膜层2例,黏膜肌层8例,黏膜下层30例,固有肌层1例。对其中不超过黏膜下层的15例行内镜下切除,2例出血,余无并发症出现。随访半年以上,1例复发,余无复发且伤口愈合良好。结论超声内镜对上消化道异位胰腺有重要的诊断价值,并可根据超声内镜所显示的病变深度决定下一步治疗,内镜下治疗是安全有效的。     

超声内镜联合EMR或ESD在食管表浅隆起性病变诊断和治疗中的作用

目的：探讨超声内镜（EUS）联合内镜下黏膜切除术（EMR）或内镜下黏膜剥离术（ESD）在食管表浅隆起性病变诊断和治疗中的价值。方法对35例经EUS检查拟诊为食管表浅隆起性病变患者进行EMR或ESD治疗的病例资料进行回顾性研究,分析病变部位的EUS图像、病理诊断结果及随访治疗效果。结果35例中21例经EMR治疗,14例经ESD治疗。经病理组织学检查确诊为早期食管癌9例,重度不典型增生5例,良性间质瘤3例,腺瘤性息肉4例,非腺瘤性息肉6例,平滑肌瘤8例。经EUS及病理证实病变均起源于黏膜层、黏膜肌层和黏膜下层。34例分别于术后1、3、6月复查EUS随访,术后1个月后伤口均完全愈合,无出血、食管狭窄及局部复发现象发生。结论联合应用EUS和EMR或ESD技术,不仅可以提高食管表浅隆起性病变早期的确诊率,而且是一种微创、有效、安全、快速的治疗措施。     

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。     

异位胰腺临床症状以及内镜下特点分析

目的探讨异位胰腺胃镜及超声胃镜下的表现。方法回顾性分析2012年3月至2015年3月经病理结果证实为异位胰腺的57例患者的临床资料,总结其临床症状、内镜及超声内镜下表现。结果 57例异位胰腺患者中,位于胃窦部最多为52例(52/57,91.2%),其余位于胃角4例,十二指肠1例。胃镜下均表现隆起病变,49例可见隆起顶部有脐样开口。超声内镜下,隆起边界不清50例,48例为不均匀混合回声病灶,低回声或等回声6例,3例为高回声病灶。6例病变位于黏膜层,47例病变为黏膜下层,2例病变累及肌层,2例病变突破肌层。结论异位胰腺无明显特异性临床表现,胃镜联合超声内镜对其诊断有重要意义。     

微探头超声指导内镜黏膜下剥离术治疗上消化道黏膜下隆起性病变的价值

背景：微探头超声（MPS）能对上消化道黏膜下隆起性病变进行较准确的定位,并初步定性诊断,内镜黏膜下剥离术（ESD）可完整切除病变,目前MPS指导ESD治疗上消化道黏膜下隆起性病变的研究少见。目的：评价MPS指导ESD治疗上消化道黏膜下隆起性病变的价值。方法：对胃镜检查发现的89例上消化道黏膜下隆起性病变行MPS检查,比较两者的诊断准确率。然后采用ESD切除病变,分析手术情况。结果：上消化道黏膜下隆起性病变以平滑肌瘤和间质瘤为主,MPS对上消化道黏膜下隆起性病变的总体诊断准确率显著高于胃镜（83．1％对51．7％,P〈0．05）。82例病变位于黏膜肌层或黏膜下层,平均直径为12．6mm,平均手术时间28．2min,ESD完整切除率100％;5例病变位于固有肌层,平均直径为13．8mm,平均手术时间48．5min,ESD完整切除率71．4％,其余2例固有肌层病变因难以控制的出血和黏连而行外科手术。所有患者术后随访无病变残留和复发。结论：MPS可对上消化道黏膜下隆起性病变作出较准确的判断,应作为内镜下治疗的术前常规检查。MPS引导ESD治疗上消化道黏膜下隆起性病变安全、有效。     

内镜超声检查术对上消化道异位胰腺的诊治价值

目的 探讨超声内镜对上消化道异位胰腺的诊治价值.方法 总结近年来于消化内镜中心经超声内镜诊断为异位胰腺并行病理检查的52例患者的临床资料,回顾性分析其图像特征及诊断准确率.结果 52例内镜超声诊断的异位胰腺者中41例患者经病理证实为异位胰腺,超声内镜诊断符合率为78.85%(41/52),其余6例为间质瘤,4例为平滑肌瘤,1例为神经鞘瘤.超声内镜下上消化道异位胰腺均表现为隆起性病变,病变位于胃窦37例,十二指肠2例,胃体1例,胃底1例;表现为高回声1例,中等回声10例,低回声18例,混杂回声12例;累及至黏膜层2例,黏膜肌层8例,黏膜下层30例,固有肌层1例.对其中不超过黏膜下层的15例行内镜下切除,2例出血,余无并发症出现.随访半年以上,1例复发,余无复发且伤口愈合良好.结论 超声内镜对上消化道异位胰腺有重要的诊断价值,并可根据超声内镜所显示的病变深度决定下一步治疗,内镜下治疗是安全有效的.     

Endoscopic removal of gastric ectopic pancreas: An initial experience with endoscopic submucosal dissection

AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.     

Long-term follow up of endoscopic resection for type 3 gastric NET

AIM:To clarify the short and long-term results and to prove the usefulness of endoscopic resection in type 3gastric neuroendocrine tumors(NETs).METHODS:Of the 119 type 3 gastric NETs diagnosed from January 1996 to September 2011,50 patients treated with endoscopic resection were enrolled in this study.For endoscopic resection,endoscopic mucosal resection(EMR)or endoscopic submucosal dissection(ESD)was used.Therapeutic efficacy,complications,and follow-up results were evaluated retrospectively.RESULTS:EMR was performed in 41 cases and ESD in 9 cases.Pathologically complete resection was performed in 40 cases(80.0%)and incomplete resection specimens were observed in 10 cases(7 vs 3 patients in the EMR vs ESD group,P=0.249).Upon analysis of the incomplete resection group,lateral or vertical margin invasion was found in six cases(14.6%)in the EMR group and in one case in the ESD group(11.1%).Lymphovascular invasions were observed in two cases(22.2%)in the ESD group and in one case(2.4%)in the EMR group(P=0.080).During the follow-up period(43.73;13-60 mo),there was no evidence of tumor recurrence in either the pathologically complete resection group or the incomplete resection group.No recurrence was reported during follow-up.In addition,no mortality was reported in either the complete resection group or the incomplete resection group for the duration of the follow-up period.CONCLUSION:Less than 2 cm sized confined submucosal layer type 3 gastric NET with no evidence of lymphovascular invasion,endoscopic treatment could be considered at initial treatment.     

Benefits of endoscopic submucosal dissection according to size and location of gastric neoplasm, compared with conventional mucosal resection

Background and Aims:  To clarify optimal therapeutic strategies for early gastric cancers without vestigial remnant or recurrence, we evaluated the benefits of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) according to tumor size and location.
Methods:  From January 2000 to December 2007, a total of 328 gastric lesions were treated using conventional EMR, while 572 lesions were treated by ESD. Patients who underwent surgery on the upper gastrointestinal tract before EMR or ESD were excluded from the study. We compared tumor size, location and rates of complete resection, curative resection, postoperative bleeding, perforation and local recurrence between EMR and ESD according to tumor situation.
Results:  Overall local complete resection rate (EMR, 64.2%; ESD, 95.1%) and overall curative resection rate (EMR, 59.5%; ESD, 82.7%) were significantly higher in ESD than in EMR. No significant differences were seen in complication rates between EMR and ESD. Local recurrence was detected in 13 lesions (4.0%) of the EMR group during follow up. In contrast, no local recurrence was detected in the ESD group. For lesions 5 mm or less in diameter, complete resection rate in the EMR group was not significantly inferior to that in the ESD group at any location. However, rates were overwhelmingly better in the ESD group than in the EMR group for lesions more than 5 mm in diameter, regardless of location.
Conclusion:  We concluded that lesions exceeding 5 mm in diameter should be treated by ESD, although a high resection rate is obtained also with EMR for lesions of 5 mm or less in diameter.     

EUS-guided mucosectomy for gastrointestinal cancer.

INTRODUCTION: the only way of improving prognosis and survival in gastrointestinal cancer is early diagnosis, with intramucosal localization as confirmed by endoscopic ultrasonography (EUS) or 20-MHz miniprobes (MPs) (T1) being most appropriate. Endoscopic mucosal resection (EMR) has proven effective in the treatment of this sort of lesions. PATIENTS AND METHOD: in a group (18 cases) with 15 cases of superficial gastrointestinal cancer and 3 cases of severe gastric dysplasia, 9 cases (3 esophageal, 4 gastric, 2 rectal) underwent a classic EMR following EUS or a 7.5- and 20-MHz miniprobe exploration. RESULTS: ultrasonographic studies showed a T1 in all but one esophageal case (Tis), and in both gastric dysplasias, with no changed layer structure being demonstrated in the latter (T0). No complications arose with classic EMR, and all 9 patients are alive and free from local or metastatic recurrence, except for one esophageal case, which recurred distally to the esophageal lesion (metachronous). CONCLUSIONS: echoendoscopically-assisted EMR is a safe, effective technique in the endoscopic management of superficial gastrointestinal (esophageal, gastric, colorectal) cancer. Recurrence most likely depends upon cancer multiplicity.     

经内镜切除消化道黏膜下肿瘤

目的 探讨内镜切除消化道黏膜下肿瘤(SMT)的疗效、安全性以及切除前内镜超声检查(EUS)的价值。方法 SMT71例中食管36例，胃29例，十二指肠和直肠各3例，64例(90．1％)治疗前行EUS检查。SMT大小6～20mm，平均14．2mm。55例用双活检管道内镜行黏膜切除术(EMR)，把持钳剥离SMT后，将其切除；6例先用圈套器在SMT基底部勒紧，再注入生理盐水，切除SMT；10例≤10mm的用透明帽吸引法切除。结果 71例SMT中68例(95．8％)内镜下完全切除；2例(1例异位胰腺、1例胃平滑肌瘤)病变残留(4周时胃镜发现)；l例直肠平滑肌瘤，未能切除改行外科手术。67例平均随访18．7个月未见复发。组织学诊断平滑肌瘤51例(71．8％)，颗粒细胞瘤、纤维瘤、异位胰腺、脂肪瘤、间质瘤和类癌共15例(21．1％)，5例(7．0％)间叶肿瘤未做免疫染色，不能确定组织来源。并发症：9例局部少量出血，1例胃间质瘤切除后胃穿孔。结论 内镜切除SMT是一种较安全、有效的方法，并可获得组织学诊断，EUS对内镜治疔SMT选择适应证有重要的价值。     

A study on gastric and small intestinal aberrant pancreas by endoscopic ultrasonography--with special reference to comparison with histological appearance

To obtain characteristic findings of gastrointestinal aberrant pancreas by endoscopic ultrasonography (EUS), we made comparison between endoscopic ultrasonograms and histological findings in 5 cases (6 lesions) of resected gastric aberrant pancreas and 1 case (1 lesion) of small intestinal one. By EUS, gastrointestinal aberrant pancreases were delineated as hypoechoic masses with blurred boundary containing fine scattered hyperechoic spots, and also there were thickening of the fourth layer below the mass. Occasionally, there were some duct-like structures within the mass or marginal lobular structures. Moreover, the ultrasonographic patterns of aberrant pancreases were classified into 2 types, that is, M and S types. On histological examination, M type cases, in which the mass attached to the thickened fourth layer by EUS, were corresponded to acinar type and the pancreatic acinar cells penetrated into the proper muscle layer of the gastrointestinal wall, whereas S type cases, in which the mass was separated from the fourth layer, to ductal or mixed type. We conclude, therefore, that not only making the accurate diagnosis of aberrant pancreas but also drawing an inference of its histological type might become possible by EUS.