超声内镜对结直肠黏膜下病变的诊断价值

目的探讨超声内镜(EUS)在结直肠黏膜下病变诊断和治疗中的作用。方法对结直肠黏膜下病变进行EUS检查。根据黏膜下病灶的起源层次,部分患者接受深挖活检、超声内镜引导下细针穿刺吸取活检术(EUS-FNA)、内镜下治疗或外科手术。回顾性分析EUS诊断结果与临床病理的相关性。结果 EUS检查的74例患者中,诊断神经内分泌肿瘤28例(均位于直肠);脂肪瘤15例(其中位于回盲部4例、横结肠1例、升结肠8例、乙状结肠2例);直肠间质瘤2例(固有肌层和黏膜肌层各1例);外压性改变14例(卵巢肿瘤9例,淋巴结2例,盆腔肿瘤3例);囊肿5例(横结肠4例、升结肠1例);气囊肿1例;乙状结肠子宫内膜异位3例;直肠周边恶性肿瘤侵犯4例;肠道淋巴瘤2例。所有病灶均接受深挖活检、EUS-FNA、内镜下治疗或外科手术。最终病理和EUS诊断符合率为68/74(91.9%),其中2例EUS考虑直肠类癌最后病理确诊为黏膜肌层来源的平滑肌瘤。1例考虑脂肪瘤最终确诊为肠道淋巴瘤。2例考虑直肠周边恶性肿瘤最终为炎性包块,1例考虑子宫内膜异位症最终诊断为直肠癌。结论 EUS能清晰地显示消化道各层结构,能清楚显示结直肠黏膜下病变的大小、起源及其与相邻结构的关系,并且能较精确地判断各种病变的性质,进而指导结直肠黏膜下病变的治疗。     

超声内镜辅助下钩刀剥离消化道黏膜下病变初探

【目的:采用超声内镜辅助下钩刀剥离消化道黏膜下病变,观察其疗效和安全性。方法:经超声内镜诊断的9例胃和结肠黏膜下病变,病变直径1.5～3.1cm,予以黏膜下注射后,超声内镜判断分离程度,予以钩刀剥离。结果:其中8例成功,1例剥离不完全。4例创面出血,3例经电灼后止,1例钛夹止血。未发生穿孔。所有病例4～8周后复查胃肠镜和超声内镜,未见复发或其他远期并发症。结论:采用超声内镜辅助下钩刀剥离消化道黏膜下病变是安全有效的。     

超声内镜检查术诊断消化道黏膜下病变的回顾性分析

目的 评估超声内镜检查术（EUS）诊断消化道黏膜下病变（SML）的临床价值。方法 回顾性分析2020年1月-2021年12月该院消化内科使用EUS诊断,并经组织病理学证实为SML患者的病例资料。结果 共有142例消化道SML患者进行了EUS检查。其中,135例为实体瘤,7例为壁外压迫。实体瘤中,EUS诊断黏膜层病变14例,黏膜肌层病变20例,黏膜下层病变62例,固有肌层病变39例,其诊断准确率分别为：100.0%、100.0%、95.0%和89.7%。EUS诊断平滑肌瘤30例（21.1%）,间质瘤29例（20.4%）,神经内分泌肿瘤25例（17.6%）,异位胰腺15例（10.6%）,息肉14例（9.9%）,脂肪瘤11例（7.7%）,囊肿9例（6.3%）,壁外压迫7例（4.9%）,颗粒细胞瘤2例（1.4%）。107例行内镜治疗或手术切除后送病检,99例病理与EUS诊断相符,EUS总体诊断准确率为92.5%。结论 EUS对消化道SML诊断的准确性与病变的起源有关,起源于黏膜层与黏膜肌层的诊断准确性最高,在鉴别壁内病变与壁外压迫方面,也具有较好的诊断价值。EUS在一定程度上可以判断SML的性...     

超声内镜在上消化道黏膜隆起型病变诊断和治疗中的应用

目的探讨超声内镜在上消化道黏膜隆起型病变的诊断和内镜治疗中的价值。方法运用超声内镜检查114例上消化道黏膜隆起型病变,并对其中26例进行超声内镜引导下病变切除术。结果黏膜隆起病变性质以间质瘤最常见,占51.8%,其次,壁外压迫占21.9%,较少见有恶性肿瘤、脂肪瘤、异位胰腺、囊肿等。对26例黏膜下肿瘤进行切除,超声诊断和病理符合率达77.0%。手术并发症少见。结论超声内镜可初步定性上消化道黏膜隆起型病变,对黏膜下肿瘤的治疗选择有指导作用;超声内镜引导下内镜切除黏膜下间质瘤安全、有效。     

Endoscopic resection of subepithelial tumors

Subepithelial tumors (SETs) are often incidentally found during endoscopic examinations. Endoscopic ultrasonography (EUS) is a good method for differential diagnosis of SETs, but a definite diagnosis cannot be made based on EUS features alone in some cases. Periodic follow-up examinations by endoscopy and EUS remains the recommended management strategy, which involves issues related to patient compliance, cost-effectiveness, and the risk associated with repeated endoscopic procedures and delayed diagnosis of malignancy. Endoscopic resection of the SETs is another technique to treat them as well as to obtain tissue specimens for accurate histologic diagnosis. Herein, a various endoscopic techniques ranging from simple snare resection to endoscopic submucosal tunnel dissection for the management of SETs will be reviewed.     

Guillotine needle biopsy as a supplement to endosonography in the diagnosis of gastric submucosal tumors.

The presumptive diagnosis of gastric submucosal tumors can be made by endoscopic ultrasonography (EUS) but histological confirmation is still required. A special guillotine biopsy device (Flexi-Temno) which enables collection of adequate submucosal samples by the endoscopic approach was therefore evaluated. After visualization by EUS the guillotine needle biopsy was performed in 21 patients with submucosal tumors of the stomach. There were 2 failures in 2 patients with leiomyomas. The diagnosis suggested by EUS was confirmed by guillotine biopsy in 17 cases. Guillotine biopsy detected 2 cases of unsuspected leiomyosarcoma which were confirmed surgically. In cases of solid submucosal tumors confirmed on EUS, the guillotine needle biopsy enables a definitive histologic diagnosis. Thus malignancies can be detected when EUS findings are not significant.     

超声内镜及内镜黏膜下剥离术对直肠类癌的诊疗价值

目的探讨超声内镜(EUS)对直肠类癌治疗的指导价值,及内镜黏膜下剥离术(ESD)对直肠类癌治疗的安全性及有效性。方法对临床考虑直肠类癌的患者进行EUS检查,根据EUS结果选择适合的治疗方案。结果 45例术前病理确诊的类癌病例,42例经ESD治疗,2例累及固有肌层及1例浸透浆膜层并伴有周围淋巴结转移者,经外科手术治疗。结论 EUS能够明确直肠类癌的大小、浸润深度、有无周围淋巴结肿大,对其治疗有较高的指导价值。对于小于20 mm直肠类癌,ESD是一种安全、有效的方法。     

超声内镜对十二指肠隆起病灶的诊断价值

该文采用超声内镜、内镜、X线钡餐造影和CT比较研究法,评价66例EUS诊断十二指肠隆起病灶的价值。结果:66例十二指肠隆起性病灶的发生率依次为壶腹癌、壁外肿瘤压迫、壁外脏器压迫、粘膜下肿瘤、息肉、乳头炎、十二指肠癌、鲍氏腺瘤、淋巴瘤。对十二指肠隆起病灶的总诊断符合率EUS为93.94％,明显高于内镜(75.76％)和钡餐造影(53.03％)。EUS对息肉、鲍氏腺瘤、乳头炎的诊断符合率低于内镜,对壶腹癌、十二指肠癌、淋巴瘤的诊断符合率则与内镜相当。EUS系目前确诊十二指肠粘膜下肿瘤及壁外压迫病灶的最佳方法。结论:该资料显示EUS诊断十二指肠隆起性病灶具有较高的价值。     

超声内镜在胃黏膜下肿瘤诊断中的局限性*

目的评估超声内镜(EUS)对胃黏膜下肿瘤(SMTs)的诊断价值,并分析胃SMTs的EUS下特点。方法收集2008年9月-2016年12月614例于该院内镜中心经EUS检查后行内镜黏膜下剥离术(ESD)切除治疗的胃SMTs患者资料纳入回顾性研究。病变起源层次以ESD术中诊断为金标准,病变类型以术后病理学及免疫组化结果为金标准,统计EUS诊断的符合率,并分析EUS结果。结果 EUS对病变起源的诊断与ESD术中结果的符合率为91.25%,其中起源于黏膜肌层、黏膜下层和固有肌层的诊断符合率分别为66.67%、80.85%和94.50%;对病变类型的诊断与ESD术后病理结果的符合率为65.99%,其中胃肠间质瘤(GIST)、平滑肌瘤、异位胰腺和脂肪瘤的诊断符合率分别为91.85%、18.56%、79.76%和90.70%。结论 EUS能初步判断胃SMTs的起源层次与病变类型,可为内镜下治疗提供较为准确的依据,但对诊断平滑肌瘤、错构瘤、炎性纤维性息肉、类癌和纤维瘤等少见病变存在一定的局限性。因此,必要时应积极地切除病变,以明确诊断,防止恶变。     

Demonstration of gastric submucosal lesions by high-resolution transabdominal sonography

PURPOSE: We evaluated the accuracy of high-resolution transabdominal sonography (TAUS) in identifying and characterizing gastric submucosal masses previously detected by endoscopy. METHODS: Patients given endoscopy for suspected submucosal gastric lesions and 2 patients with gastric wall cysts were enrolled. Patients underwent TAUS and then endoscopic sonography (EUS) on the same day, and the sonographic results were compared with endoscopic and histologic findings. RESULTS: Among 101 patients with gastric submucosal masses on endoscopy, TAUS revealed a mass in 94 (93%); of these 94 patients, 60 underwent EUS. The final diagnoses were 31 leiomyomas, 10 leiomyosarcomas, 13 ectopic pancreases, 2 cysts, and 1 glomus tumor, 1 carcinoid tumor, 1 lipoma, and 1 fibroma. Leiomyomas (mean size, 3.2 cm) and leiomyosarcomas (mean size, 7.1 cm) were shown sonographically to originate from the muscular layer. Ectopic pancreases (mean size, 1.2 cm) were shown to originate from the submucosal layer and had a homogeneously echogenic pattern. Gastric cysts were found in the submucosal layer and were anechoic. The glomus tumor and the carcinoid tumor were found in the muscular layer and were hypoechoic. The lipoma and the fibroma were located in the submucosal layer and were echogenic on TAUS. CONCLUSIONS: TAUS had a detection rate of 93% in visualizing submucosal gastric masses previously identified by endoscopy. TAUS is less invasive than EUS and can be used to follow submucosal gastric masses that are not excised.     

Endoscopic ultrasound: contrast enhancement

The development of ultrasound contrast agents has allowed for the evaluation of vascularity in digestive organs by contrast-enhanced endoscopic ultrasonography (EUS). Contrast-enhanced Doppler EUS and contrast-enhanced?harmonic EUS (CH-EUS) have improved characterization of pancreatic tumors, lymph nodes, and gastrointestinal submucosal tumors and compliment EUS fine-needle aspiration (FNA) in identifying malignant tumors. Moreover, CH-EUS can be used to identify the target for EUS-guided FNA by clearly depicting the outline of the lesions.     

超声内镜指导下食管间质瘤黏膜切除术

目的探讨超声内镜指导下食管间质瘤黏膜切除术的意义。方法对2005年～2007年5月76例疑为消化道黏膜下肿瘤的患者进行超声内镜检查,其中34例食管病变超声内镜显示病变来源于黏膜下层,有24例经知情同意后行超声内镜下黏膜切除术。切除的病变经过病理检查明确病变的层次和病变性质。结果通过与病理结果对照表明,超声内镜检查能准确地判断肿瘤所在层次;通过黏膜切除术切除所有的病变,无1例发生并发症。结论超声内镜指导食管间质瘤黏膜切除术既准确又安全。     

Early esophageal carcinoma: endoscopic ultrasonography using the sonoprobe

Background: Almost all cases of superficial esophageal carcinoma are curable by endoscopic mucosal resection (EMR), but a precise diagnosis of the depth of tumor invasion is necessary to assess the indication for EMR. Although endoscopy has a high rate of accuracy for diagnosing the depth of tumor invasion, it depends on the experience of the examiner in interpreting surface information of the lesions. Today, endoscopic ultrasonography (EUS) is one of the most powerful techniques for obtaining objective tomographic images of a tumor. The high-frequency ultrasound probe is appropriate for EUS in cases of superficial esophageal carcinoma because of its excellent near-field resolution that provides precise ultrasound images under direct control of the endoscope. Methods: We performed EUS with the Sonoprobe System in 85 cases of superficial esophageal carcinoma before treatment and evaluated the resected specimens histopathologically. We interpreted the depth of tumor invasion based on our fundamental studies of ultrasonograms taken with a 20-MHz probe. Results: The clinical usefulness of the Sonoprobe with linear and radial scanning modes is due to its capacity to differentiate between mucosal and submucosal carcinoma by means of analyses of the muscularis mucosae. Although a clear assessment of microinvasion and lymphoid hyperplasia surrounding the tumor of interest remains speculative, the diagnostic accuracy rate for 96 lesions of superficial esophageal carcinoma reached 93% in terms of differentiating between mucosal from submucosal carcinoma. Conclusion: EUS with the Sonoprobe can play an important role in the pretreatment diagnosis of superficial esophageal carcinomas.     

Endoscopic ultrasonography

Areas of application for endosonography can be roughly divided into three categories: standard diagnostic examination; operative diagnostic examination (fine-needle aspiration); and operative therapeutic procedures. Nevertheless, endoscopic ultrasonography remains a single technique, in which the physician can not only raise a suspicion of a particular disease, but can also obtain cytological confirmation when needed and carry out a therapeutic procedure when indicated. Widely accepted indications for endosonography are the staging of esophageal and rectal cancer, and the visualization of submucosal lesions and gastric wall diseases; other indications, such as imaging of the pancreas and biliary tree, are still being discussed.     

超声内镜结合窄带放大内镜下JNET分型对结直肠肿瘤性病变浸润深度评估的价值

目的探讨日本窄带成像技术专家小组(JNET)分型联合超声内镜(EUS)在结直肠肿瘤性病变浸润深度判断中的临床应用价值。方法回顾性分析2019年10月至2020年10月衡水市人民医院内镜诊疗中心发现的86例结直肠息肉样病变患者的临床资料。所有患者术前均按JNET分型对病变微血管分型,并用EUS评估其浸润深度;与内镜下黏膜切除术、黏膜下剥离术、外科手术所获组织病理结果加以对比;以病理结果为金标准,分析EUS联合JNET分型判定结肠肿瘤性病变浸润深度的可靠性,并与单用JNET分型评估进行对比,一致性分析采用Kappa检验。结果86例患者94个病灶,JNET分型1型与病理诊断增生性息肉/无蒂锯齿状息肉(SSP)的符合率为82.1%(23/28),2A型与病理诊断低级别上皮内瘤变(LGIN)的符合率84.1%(32/38),2B型与病理诊断高级别上皮肉瘤变(HGIN)/黏膜内癌(M)/黏膜下浅层浸润癌(SM-s)的符合率为65.2%(15/23),3型与病理诊断黏膜下深层浸润癌(SM-d)的符合率为61.1%(11/18)。以病理结果为准,EUS联合JNET分型判断病变浸润深度的准确度为97.06%(33/34);一致性检验结果提示,单独JNET分型与病理诊断结果一致性中等(Kappa值0.580,P<0.01),而EUS联合JNET分型与病理诊断结果一致性较高(Kappa值0.940,P<0.01)。结论JNET分型与病理诊断具有一定符合率,但部分亚型符合率仍较低,JNET分型与EUS联合在结直肠肿瘤性病变浸润深度判断中的准确度高于单用JNET分型。     

Evaluation of transabdominal ultrasound after oral administration of an echoic cellulose-based gastric ultrasound contrast agent for demonstrating small gastric subepithelial masses

Purpose

To assess the role of transabdominal ultrasound after oral administration of an echoic cellulose-based gastric contrast agent (TUS-OCCA) for detection and characterization of small gastric subepithelial masses (≤3 cm) by comparison with endosonography (EUS).

Methods

Ninety-five patients with small gastric subepithelial masses detected by gastroscopy examination were enrolled. For each patient, TUS-OCCA was performed prior to EUS by a skilled examiner. TUS-OCCA diagnoses were compared with those of EUS.

Results

TUS-OCCA had a detection rate of 94% (89 of 95) in visualizing small gastric subepithelial masses previously detected by gastroscopy. The sizes of 6 undetected masses ranged from 7 to 12 mm (4 located at the fundus, 2 at the cardia). All of six patients whose lesions were undetected by TUS-OCCA were obese. The findings of gastric subepithelial masses demonstrated by TUS-OCCA were similar to that shown on EUS.

Conclusions

TUS-OCCA can provide useful information about small gastric subepithelial masses, especially for the patients who are not obese. It can be used to follow gastric submucosal tumors that are not excised.     

Local endoscopic removal of duodenal carcinoid tumors

A swift and aggressive diagnostic and therapeutic approach is advisable when managing submucosal or polypoid lesions in the duodenum, since it is not possible to distinguish small, benign, and unremarkable duodenal growths macroscopically from malignant tumors such as carcinoids. This paper presents a systematic review of the published literature listed in Medline, focusing on the results after endoscopic treatment of duodenal carcinoids during the last 15 years; on the biological behavior of duodenal carcinoids; and on the endoscopic appearance of duodenal carcinoids. Endoscopic ultrasonography (EUS) is extremely useful in the diagnostic and preoperative work-up. The results indicate that endoscopic removal of duodenal carcinoids smaller than 1 cm that are located outside the periampullary region, with no EUS signs of invasion of the muscularis propria, is a safe, patient-friendly, adequate, and effective treatment.     

内镜超声检查对上消化道隆起性病灶的诊断价值

目的：探讨内镜超声检查（EUS）在上消化道隆起性病灶的诊断与鉴别诊断中的价值。方法：回顾分析2002年1月至2006年6月本院1060例上消化道隆起性病变患者的EUS诊断结果，并与其手术、病理诊断及临床随访结果对照。同时比较EUS与CT检查在黏膜下肿瘤（SMTs）定位及定性诊断中的价值。结果：1060例上消化道隆起性病变中，发生于食管者355例（33．5％），胃618例（58．3％），十二指肠87例（8．2％）；EUS诊断为间质瘤260例（24．5％），平滑肌瘤221例（20．8％），脂肪瘤17例（1．6％），腔外压迹221例（20．8％），息肉94例（8．9％），恶性肿瘤96例（9．1％），囊肿57例（5.4％），血管瘤7例（0．7％），炎性皱襞45例f4．2％），静脉曲张21例（2．0％），血肿1例f0．1％）及异位胰腺20例（1．9％）。对EUS诊断SMTs的进一步分析发现，EUS对SMTs性质和来源层次的判断准确率达90．6％和86．9％；与CT比较，EUS在SMTs定位（95．8％比72．9％，P〈0．001）和定性（93．8％比64．6％，P〈0．001）诊断方面明显优于CT，在良、恶性鉴别诊断方面，CT组与EUS组间差异无统计学意2／．（91．7％比89．6％，P〉0．05）。结论：EUS对上消化道隆起性病灶诊断有较大价值，进一步为制定临床处理方案提供重要的影像学依据。     

超声内镜辅助下套扎治疗上消化道黏膜下肿瘤的临床研究

目的探讨超声内镜辅助下橡皮圈套扎治疗上消化道黏膜下肿瘤(submucosal tumor, SMT)的适应证、疗效及并发症等。方法选取近年来经超声内镜确诊患有上消化道黏膜下肿瘤的患者69例共71枚病变,所有患者均于超声内镜评估后行橡皮圈套扎治疗,术后常规给予质子泵抑制剂治疗,并于2~4周后复查胃镜。结果肿瘤直径0.5~1.5 cm,病变位于食管32枚（45.1%）,胃23枚（32.4%）,十二指肠16枚（22.5%）;位于黏膜深层28枚（39.4%）,黏膜下层20枚（28.2%）,固有肌层23枚（32.4%）;病变形态广基56枚（78.9%）,亚蒂15枚（21.1%）;一次性套扎成功63枚（88.7%）,失败8枚（11.3%）,对治疗成功与失败组病变进行进一步分析显示,肿瘤大小、起源层次及质地是决定此方法是否成功的关键因素。结论对上消化道黏膜下肿瘤进行超声内镜检查,能够获取病变起源、大小以及弹性等信息,是临床开展橡皮圈套扎治疗的重要术前诊断方法。     

深在性囊性胃炎6例诊治分析

目的分析深在性囊性胃炎临床表现、CT、胃镜、超声内镜检查,以及治疗方式,提高对该病的认识。方法回顾分析6例深在性囊性胃炎的临床表现、CT、胃镜、超声内镜及病理资料。结果 6例患者中CT提示3例为胃癌,3例考虑胃部肿块。胃镜均提示隆起病变。超声内镜均诊断为深在性囊性胃炎。6例患者均行内镜黏膜下剥离术(ESD),病理均符合深在性囊性胃炎。结论超声内镜结合内镜黏膜切除术(EMR)或ESD可以提高诊断率,对于不伴随恶性肿瘤的深在性囊性胃炎,可行ESD治疗。