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1.
Among submucosal tumors (SMT), gastric glomus tumors are rare vascular tumors, and only a few cases where glomus tumors have been differentiated from other mesenchymal tumors by endoscopic ultrasonography (EUS) or computed tomography (CT) have been reported. In this case series, we aimed to analyze the EUS and CT characteristics of gastric glomus tumors. Seven patients with gastric glomus tumors were retrospectively enrolled in this study. EUS showed that all the tumors were located in the fourth EUS layer (muscularis propria) and had distinct borders. The tumors had a heterogeneous appearance with either hypo‐ or hyperechogenicity, and all the tumors except one had the characteristic peripheral halo around them. On CT scans,all the tumors appeared as well‐defined SMT with a clear margin and showed the same characteristics in the different phases of CT. During dynamic contrast‐enhanced CT, the tumors showed strong enhancement in the arterial phase and prolonged enhancement in the delayed phase. This case series shows the characteristic EUS findings and the distinguishing features of CT scans for gastric glomus tumors; these findings will help in differentiating gastric glomus tumors from other SMT. 相似文献
2.
经黏膜下隧道内镜肿瘤切除术治疗源于固有肌层的上消化道黏膜下肿瘤初探 总被引:1,自引:0,他引:1
目的探讨经黏膜下隧道内镜肿瘤切除术(STER)治疗来源于上消化道固有肌层黏膜下肿瘤(SMTs)的疗效和安全性。方法对26例经超声内镜和CT诊断为来源于固有肌层的上消化道SMTs患者全麻下行STER治疗:(1)内镜寻找到肿瘤,并准确定位;(2)建立黏膜下隧道,显露肿瘤;(3)内镜直视下完整切除肿瘤;(4)缝合黏膜切口。结果来源于固有肌层的上消化道SMTs患者26例中,食管14例,贲门7例,胃5例。来源于固有肌层浅层者11例,深层者15例,其中2例胃SMTs与浆膜层粘连,密不可分。STER成功切除所有黏膜下肿瘤,完整切除率100%,切除病变直径1.0~3.2cm(平均1.9cm)。黏膜切开至黏膜切口完整缝合时间25~145min,平均68.5min;完整缝合创面所用金属夹4—6枚,平均5枚。术后病理诊断为平滑肌瘤17例,间质瘤7例,血管球瘤1例,神经鞘膜瘤1例;切缘均为阴性。发生皮下气肿2例,左侧气胸伴皮下气肿1例,气腹2例,均予保守治疗痊愈。术后无一例出现迟发性消化道出血、消化道漏和胸腔腹腔继发感染,无一例发生黏膜下隧道内积血积液和继发感染。随访3~9个月,无一例病变残留或复发。结论STER治疗来源于固有肌层的上消化道SMTs安全、有效,可以一次性完整切除病变,提供完整的病理学诊断资料,并可避免消化道漏和胸腔腹腔继发感染。 相似文献
3.
Accuracy of endoscopic ultrasonographic impression compared with pathologic diagnosis in gastrointestinal submucosal tumors] 总被引:1,自引:0,他引:1
Joong Goo Kwon Eun Young Kim Young Sup Kim Jong Woon Chun Jin Tae Chung Sung Soo You Hyung Keun Ha Chang Hyeong Lee Ho Gak Kim Chang Ho Cho 《Taehan Sohwagi Hakhoe chi》2005,45(2):88-96
BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is a valuable imaging modality for the evaluation of gastrointestinal submucosal tumor (SMT). EUS is helpful in assessing the layer of origin, tumor diameter, shape, border characteristics, and internal echo patterns of SMTs and thus makes it possible to predict histologic diagnosis with educated guess. However, some studies have found no significant differences in EUS features between benign and malignant mesenchymal tumors. By comparing EUS impressions with histologic diagnosis, we evaluated the accuracy of EUS in differential diagnosis of gastrointestinal SMTs. METHODS: 58 cases of gastrointestinal SMTs with both EUS findings and pathologic reports were compared retrospectively from August 2001 to September 2003. RESULTS: 34 patients had lesions in the stomach and 13, 8, 3 in the esophagus, duodenum, and colon respectively. Benign lesions were predominant (46 of 58). The EUS and pathologic diagnosis coincided in 46/58 (79.3%) of the cases. Use of EUS led to the correct diagnosis in 7/9 (77.8%) of malignant GISTs (gastrointestinal stromal tumor) and leiomyosarcomas. Two small malignant gastric GISTs were diagnosed as benign with EUS. CONCLUSIONS: EUS is a useful tool in the differential diagnosis of gastrointestinal SMTs and predicting malignant lesions. However, some malignant GISTs were diagnosed as benign tumor with EUS examination. 相似文献
4.
目的探讨微型探头超声内镜(InEus)在上消化道黏膜下肿瘤的诊断和治疗中的作用。方法对30例疑为上消化道黏膜下肿瘤的患者进行微型探头超声内镜检查,根据黏膜下肿瘤的起源层次.部分患者接受内镜下治疗或外科手术。结果mEUS检查的30例患者中,发现消化道壁外压迫1例(主动脉弓1例);黏膜下肿瘤29例,包括平滑肌瘤12例,良性间质瘤4例,恶性间质瘤1例,脂肪瘤4例,静脉瘤3例,异位胰腺1例,囊肿4例。12例起源于黏膜肌层的肿瘤行高频电切除术切除,3例静脉瘤行尼龙圈套结扎,4例脂肪瘤及4例囊肿行高频电切除。结论mEUS检查能清楚显示上消化道黏膜下肿瘤的大小.起源层次、生长方向及邻近组织结构关系,较准确地判断肿瘤的性质。进而指导黏膜下肿瘤治疗方案的选择。 相似文献
5.
The clinical value of endoscopic ultrasonography (EUS) in the diagnosis of submucosal tumors (SMTs) of the stomach was examined. We used echo endoscopes with a 7.5 or 10.0 MHz radial-scan transducer made by Olympus Co. Ltd. EUS was carried out on 80 patients with SMTs of the stomach including 54 cases confirmed histologically (24 cases of leiomyoma, 3 of leiomyosarcoma, 12 of cysts, 7 of aberrant pancreas, 4 of lipoma, 2 of carcinoid, and 3 of other diseases). Fifty-nine patients with extraluminal compression were detected by endoscopy and/or x-ray examination. We examined the effectiveness of EUS based on our analysis of the gastrointestinal tract wall seen in the EUS image as a five-layered structure corresponding with that of the histological layers. As a result, SMTs and extragastric compression were easily distinguishable in the EUS images of the lesions. The size, location, and origin of the SMTs could be detected. From the location of the SMT in the five-layered structure seen in the EUS image we could predict its histological nature. Thus, EUS was a most valuable method not only in the diagnosis of intramural and extramural SMTs but also in the detection of extragastric compressive lesions and organs. 相似文献
6.
Jun MATSUMOTO Kazuaki NAKASHIO Junichi YOSIKAWA Keizo TANAKA Tadashi SHIBUE 《Digestive endoscopy》1989,1(1):36-42
Abstract: The usefulness and the problems of endoscopic ultrasonograpy (EUS) in the diagnosis of submucosal tumors (SMT) of the upper alimentary tract were evaluated in this study. EUS was carried out in 86 cases with SMT of the stomach. Tumors of 13 cases was confirmed histologically (leiomyoma in 7 cases, leiomyosarcoma in one, lipoma in 2, gastric cyst in one, aberrant pancreas in one and Schwannoma in one case). In only one out of 22 cases with SMT of the esophagus, the tumor was surgically resected and a pathological examination revealed leiomyoma EUS was useful in estimating the histological origin of SMT by observation of the relationship between the location of the tumor and each layer in the gastric or esophageal wall. However, it was imposible to differentiate leiomyoma from leiomyosarcoma in myogenic tumors through the echoic pattern of the tumor by EUS alone at the present time. EUS was also useful in distinguishing the cause of extragastric compression showing similar findings with SMT, which could not be clarified by X-ray or endoscopic examination. In fact, organs compressing the stomach were easily clarified by EUS. It was decided that EUS should be performed in all cases whenever there is any doubt of SMT existing after an X-ray or endoscopic examination. 相似文献
7.
目的探讨内镜全层切除术(EFR)治疗源于固有肌层的胃黏膜下肿物(SMT)的疗效和安全性。方法 25例于2011年1月至2013年9月于我院接受EFR治疗的胃SMT患者纳入研究,肿瘤经EUS和增强CT检查诊断为来源于固有肌层。对其治疗结果、并发症发生情况、近期随访结果等进行回顾性分析。结果 25例均完整切除病灶,病灶长径1.0~5.5 cm,黏膜切开至黏膜切口完整缝合时间为60~180 min,使用止血夹5~30枚,住院天数3~9 d,医疗费用8 000~20 000元。术后病理诊断间质瘤22例,平滑肌瘤2例,神经鞘瘤1例,切缘均为阴性。术后无出血,1例出现腹膜炎。出院后3个月内镜复查未见病变残留、复发。结论 EFR治疗来源于固有肌层的胃SMT安全、有效,可成为胃SMT的治疗选择。 相似文献
8.
Papanikolaou IS Triantafyllou K Kourikou A Rösch T 《World journal of gastrointestinal endoscopy》2011,3(5):86-94
Gastric submucosal tumors(SMTs) are a rather frequent finding,occurring in about 0.36%of routine upper GIendoscopies.Endoscopic ultrasonography(EUS) has emerged as a reliable investigative procedure for evaluation of these lesions.Diagnostic EUS has the ability to differentiate intramural tumors from extraluminal compressions and can also show the layer of origin of gastric SMTs.Tumors can be further characterized by their layer of origin,echo pattern and margin.EUS-risk criteria of their malignant potential are presented,although the emergence of EUS-FNA has opened new indications for transmural tissue diagnosis and expanded the possibilities of EUS in SMTs of the stomach.Tissue diagnosis should address whether the SMT is a Gastrointestinal stromal tumour(GIST) or another tumor type and evaluate the malignant potential of a given GIST.However,there seems to be a lack of data on the optimal strategy in SMTs suspected to be GISTs with a negative EUS-FNA tissue diagnosis.The current management strategies,as well as open questions regarding their treatment are also presented. 相似文献
9.
无腹腔镜辅助的内镜全层切除术治疗源于固有肌层的胃黏膜下肿瘤 总被引:6,自引:1,他引:5
目的探讨无腹腔镜辅助的内镜全层切除术(EFR)治疗源于固有肌层的胃黏膜下肿瘤(SMT)的疗效和可行性。方法2007年7月至2009年8月经辅助检查和前期治疗明确诊断为起源于固有肌层的胃SMT患者20例,择期行全麻下EFR治疗:(1)黏膜下注射生理盐水,预切开肿瘤周围黏膜和黏膜下层,显露肿瘤;(2)采用内镜黏膜下剥离术(ESD)技术沿肿瘤周围分离固有肌层至浆膜层;(3)应用Hook刀沿肿瘤边缘切开浆膜;(4)胃镜直视下应用Hook、IT刀或圈套器完整切除包括浆膜在内的肿瘤;(5)应用金属夹缝合胃创面。结果20例源于固有肌层的胃SMT中,病灶位于胃底9例、胃体11例。EFR成功切除所有病变,完整切除率为100%,未使用腹腔镜辅助;EFR时间为60—145min,平均85min。切除肿瘤最大直径1.8~3.5cm,平均2.6cm;病理诊断为问质瘤13例、平滑肌瘤4例、血管球瘤2例、神经鞘瘤1例。术后无一例出现胃出血、腹膜炎体征及腹腔脓肿,术后3d造影无一例造影剂外漏和胃排空障碍。住院天数3~8d,平均5.5d。术后随访1~12个月,平均7个月,无一例病变残留或复发。结论EFR治疗源于固有肌层的胃SMT是安全、有效的,可以切除更深的胃壁肿瘤,并提供准确的病理诊断资料,它的开展可进一步扩大内镜治疗的适应证。 相似文献
10.
Masahide Ebi Tomoya Sugiyama Kazuhiro Yamamoto Takuya Saito Tadahisa Inoue Yoshiharu Yamaguchi Yasuhiro Tamura Shinya Izawa Yasutaka Hijikata Yasushi Funaki Naotaka Ogasawara Makoto Sasaki Kunio Kasugai 《Clinical journal of gastroenterology》2017,10(6):508-513
Gastric glomus tumors are extremely rare, constituting approximately 1% of gastric mesenchymal tumors. We report the case of a 45-year-old female patient in whom upper gastrointestinal endoscopy revealed a 3-cm submucosal tumor with a bridging fold in the posterior wall of the antrum of the stomach. Contrast-enhanced computed tomography revealed the tumor to be hypervascular in the arterial phase and exhibit continuous enhancement in the post-venous phase. Dynamic contrast-enhanced magnetic resonance imaging showed that the tumor was hypervascular in the early phase and persistently enhanced in the late phase. Endoscopic ultrasonography revealed a mosaic echo pattern. Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed. Immunohistochemical examination revealed that the tumor was positive for α-smooth muscle actin and synaptophysin, but negative for CD56, chromogranin A and C-kit. Furthermore, 1–2% of the tumor cell nuclei were Ki-67-positive. Thus, the preoperative diagnosis was a benign glomus tumor. The patient then underwent non-exposed endoscopic wall-inversion surgery (NEWS), and the tumor was completely resected. In conclusion, NEWS is an effective method for the treatment of gastric glomus tumors. 相似文献
11.
Sahai AV Siess M Kapfer B Ponchon T Palazzo L Yasuda K Rösch T 《The American journal of gastroenterology》2003,98(9):1989-1995
OBJECTIVES: Our prospective clinical study of prospectively compared physicians' management of submucosal tumors (SMTs) with and without endoscopic ultrasound (EUS). It showed that EUS reduced further tests by more than 50%, but it is unclear whether it reduced the overall costs. The aim of this study was to determine whether EUS would reduce costs. METHODS: Based on the data from the clinical study, a decision analysis was created to compare the direct hospital costs for diagnosing SMTs with and without EUS. Cost data from Germany, Canada, Japan, France, and the United States were used. Costs were expressed as a ratio of the cost of esophagogastroduodenoscopy (EGD). Average cost ratios for each procedure were as follows (sensitivity analysis ranges are 95% CIs): EGD = 1; large particle biopsy (LPB) 0.75 (0.22-1.24); endoscopic ultrasound (EUS) 2.0 (1.22-2.79); abdominal ultrasound (US) 0.77 (0.31-1.24); computed tomography (CT) 1.79 (0.64-2.95); magnetic resonance imaging (MRI) 3.54 (1.28-5.79); and ERCP 3.45 (0.82-6.07). RESULTS: Initial inputs show the "no EUS" strategy is less costly when cost data for all countries are averaged (expected cost 2.13 vs 2.71, expressed as a ratio of the cost of EGD]) and for all countries individually except Germany. In descending order, overall management costs were most sensitive to the relative costs of CT and EUS, the cost of LPB, and to the probability of no further testing when the "no EUS" strategy is used. However, threshold analysis showed that changes in only one variable, the ratio of the cost of EUS compared to CT (the "EUS/CT ratio"), were able to shift the optimal strategy from "no EUS" to "EUS." "EUS" becomes less costly only if the EUS/CT cost ratio is <0.85 (i.e., if the cost of EUS is <85% that of CT). If the potential for EUS to reduce severe complications caused by LPB of high risk lesions is incorporated, "EUS" is less costly if this risk is >2% (range 1-5%). CONCLUSIONS: When used to diagnose SMTs, EUS may reduce the need for further tests but not necessarily costs. For this indication, the relative cost of EUS compared with CT is what most limits its potential value as a cost-minimizing test. The costs, economic impact, and hence the relative appropriateness of EUS and other procedures may vary in different health care systems. 相似文献
12.
Kawahira H Hayashi H Natsume T Akai T Uesato M Horibe D Mori M Hanari N Aoyama H Nabeya Y Shuto K Matsubara H 《Hepato-gastroenterology》2012,59(114):415-417
Background/Aims: The treatment of gastric submucosal tumors (SMTs) is strictly surgical and enucleation of the tumor or wedge resection of the stomach is efficient to achieve R0 resection. Laparoscopic and endoscopic cooperative surgery (LECS) can be safely performed with adequate cutting lines. This study describes the initial 16 cases treated by LECS and evaluates the advantages by LECS for gastric SMTs retrospectively. Methodology: Sixteen patients with gastric SMT underwent LECS from June 2007 to December 2010, their surgical data, clinical characteristics and surgical specimens of SMTs were compared. The surgical specimens of 9 gastric SMTs treated by laparoscopic wedge resection (LWR) were compared as a control. Results: The median (range) length of operation time, blood loss, hospital stay after surgery were minutes 172 (115- 220), <5mL (<5-115) and 10 days (6-17), respectively. The median (range) ratio of the longest diameter of the tumor divided by the longest diameter of the surgical specimen in LECS and LWR were 0.86 (0.625-1.0) and 0.69 (0.44-1.0), respectively (p=0.0189, Wilcoxon rank sum test). Conclusions: LECS minimizes the surgical specimen while still providing sufficient surgical margins to successfully cure gastric SMTs. 相似文献
13.
《Digestive and liver disease》2021,53(11):1486-1491
Backgroundstandard B-mode EUS assessment and EUS-guided tissue acquisition present sub-optimal diagnostic yield in the differential diagnosis of gastric submucosal tumors (SMTs).Aimsto evaluate the performances of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) to differentiate gastric SMTs and predict malignancy risk of gastrointestinal stromal tumors (GIST).Methodsa retrospective analysis was performed retrieving consecutive patients with gastric SMTs who underwent EUS between 2009 and 2014. Patients with available EUS video recordings and histological diagnosis were included. De-identified videos were presented to experts who made a diagnosis on B-mode EUS and CH-EUS.Resultsfifty-four patients (29 female, 64-year-old) were included. Final diagnoses were 40 GISTs (8 high-grade), 9 leiomyomas, 5 rare SMTs. The sensitivity, specificity, and accuracy of B-mode and CH-EUS for the differential diagnosis of GIST were 95.0% vs. 85.0%, 57.1% for both techniques, and 85.2% vs. 77.8%, respectively. The sensitivity, specificity, and accuracy of B-mode and CH-EUS for the estimation of the malignancy GISTs risk were 62.5% vs. 100%, 83.3% vs. 82.1%, and 78.9% vs. 86.1%, respectively.ConclusionsCH-EUS showed better diagnostic performance than B-mode EUS in differentiating leiomyomas and risk stratification of GIST. When considering high-grade GISTs, the addition of CH-EUS allowed an improvement in diagnostic accuracy. 相似文献
14.
Glomus tumors are benign lesions and originate from modified smooth muscle cells of the glomus body. These tumors are commonly observed in the dermis or subcutis, but only rarely found in the stomach. Here we report a case of a 67-year-old patient in whom glomus tumor of the stomach was diagnosed after 10-day history of melena. We have reviewed the 13 cases selected from literature of gastric glomus tumor in Korean, including our case. The age of onset ranged from 30 to 68 years (median 54 y) with a strong female dominance (10 females and 3 males). The tumors typically presented with gastrointestinal bleeding or ulcerlike symptom, and 6 tumors had mucosal ulceration. The tumor sizes varied from 1.2 to 3.8 cm (median 2.5 cm), and all tumors presented in antrum of stomach. Microscopically, the tumors were well-circumscribed, and composed of uniform, small, round to polygonal cells. Mitotic activity was usually low. The characteristics of gastric glomus tumors in Korean patients are very similar to those of Western populations. Although gastric glomus tumors can be considered more likely benign, a small possibility of malignant behavior cannot be ruled out. 相似文献
15.
M J Varas J M Miquel R Abad J C Espinós M A Ca?as R Fabra D Bargalló 《Revista española de enfermedades digestivas》2007,99(3):138-144
INTRODUCTION AND OBJECTIVE: interventionist endoscopic ultrasonography is increasingly used because of its growing indications. We present here our retrospective and initial experience (60 procedures) with endoscopic ultrasonography (EUS) both for diagnosis (EUS-FNA) and therapy (EUS-guided tumorectomy and mucosectomy). PATIENTS AND METHOD: in a group with 27 cases including 10 submucosal tumors (SMTs), 2 adenopathies, and 15 potential pancreatic tumors (8 pancreatic cancers), a sectorial EUS-FNA at 7.5 MHz was performed for diagnosis prior to therapy (mainly surgical). A pancreatic pseudocyst was drained. In 21 cases with 27 SMTs (10 patients with 13 carcinoids) a tumorectomy was carried out using the standard loop or assisted polypectomy technique with submucosal injection, and in a few cases (two) using elastic band ligation following a radial EUS at 7.5, 12, or 20 MHz. In 6 cases of superficial gastroesophageal cancer or gastric dysplasia an endoscopic mucosal resection (classic EMR) was performed after EUS or MPs at 7.5 and 20 MHz. Fifty-five patients with 60 lesions, 29 femaes and 26 males with a mean age of 60 years (30-88 years) were retrospectively analyzed. RESULTS: diagnostic precision (P), sensitivity (S), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) for EUS-FNA was 85, 83, 100, 100, and 43%, respectively, when comparing results with specimen histology. P was higher for adenopathies (100%) and pancreatic tumors (87%) than for SMTs (80%). No complications arose, except for one episode of upper gastrointestinal bleeding (UGIB) (3.7%) that was endoscopically and satisfactorily treated in a gastric SMT. In the group with 21 patients (10 carcinoids with 13 tumors) 27 SMTs were endoscopically treated by tumorectomy with no perforation and only 2 UGIBs (7.4%), one of them self-limited, recorded.Endoscopic resection was complete in 92% of cases. No complications occurred with classic EMR, and all patients are still alive with no evidence of relapse, either local or metastatic. In this group the rate of complete resections was 100%. CONCLUSIONS: EUS-FNA is a safe technique with high diagnostic accuracy. EUS-guided tumorectomy and mucosectomy are also safe and effective techniques in the endoscopic management of these tumors. 相似文献
16.
Shin Kato Kaoru Kikuchi Kenji Chinen Takahiro Murakami Fumihito Kunishima 《World journal of gastroenterology : WJG》2015,21(22):7052-7058
A 52-year-old man was referred for further investigation of a gastric submucosal tumor on the greater curvature of the antrum. Endoscopic ultrasonography demonstrated a hypoechoic solid mass, which was primarily connected to the muscular layer of the stomach. We performed endoscopic ultrasoundguided fine-needle aspiration biopsy. The pathological examination showed proliferation of oval-shaped cells with nest formation, which stained strongly positive for muscle actin, and negative for c-kit, CD34, CD56,desmin, S-100, chromogranin, and neuron-specific enolase. Therefore, we performed laparoscopy and endoscopy cooperative surgery based on the preoperative diagnosis of glomus tumor of the stomach. The final histological diagnosis confirmed the preoperative diagnosis. Although preoperative diagnosis of glomus tumor of the stomach is difficult with conventional images and endoscopic biopsy, endoscopic ultrasoundguided fine-needle aspiration biopsy is an essential tool to gain histological evidence of glomus tumor of the stomach for early diagnosis. 相似文献
17.
Ponsaing LG Kiss K Loft A Jensen LI Hansen MB 《World journal of gastroenterology : WJG》2007,13(24):3301-3310
This review is part one of three, which will present an update on diagnostic procedures for gastrointestinal (GI) submucosal tumors (SMTs). Part two identifies the classification and part three the therapeutic methods regarding GI SMTs. Submucosal tumors are typically asymptomatic and therefore encountered incidentally. Advances in diagnostic tools for gastrointestinal submucosal tumors have emerged over the past decade. The aim of this paper is to provide the readers with guidelines for the use of diagnostic procedures, when a submucosal tumor is suspected. Literature searches were performed to find information on diagnostics for gastrointestinal submucosal tumors. Based on the searches, the optimal diagnostic procedures and specific features of the submucosal tumors could be outlined. Standard endoscppy, capsule endoscopy and push-and- pull enteroscopy (PPE) together with barium contrast X-ray do not alone provide sufficient information, when examining submucosal tumors. Endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI) and fluorodeoxyglucose-labeled positron emission tomography (FDG-PET) are recommended as supplementary tools. 相似文献
18.
We describe here a case of 51-year-old woman with a symptomatic hepatic cyst that was misdiagnosed as a gastric submucosal tumor (SMT) with endoscopic ultrasound (EUS) and CT scan. The patient presented with an epigastric pain for two months. On endoscopy, a submucosal tumor was found on the cardia of the stomach. Based on EUS and abdominal CT scan, the lesion was diagnosed as a gastric duplication cyst or a gastrointestinal stromal tumor (GIST). The operative plan was laparoscopic wedge resection for the GIST of the gastric cardia. A cystic mass arising from the left lateral segment of the liver was found at the laparoscopic examination. There was no abnormal finding at the gastric cardia. She was treated by laparoscopic hepatic wedge resection including the hepatic cyst using an endoscopic linear stapler. 相似文献
19.
Endoscopic enucleation of upper-GI submucosal tumors by using an insulated-tip electrosurgical knife 总被引:4,自引:0,他引:4
Park YS Park SW Kim TI Song SY Choi EH Chung JB Kang JK 《Gastrointestinal endoscopy》2004,59(3):409-415
BACKGROUND: Submucosal tumors often are found incidentally at upper endoscopy. Although the majority of the ones less than 5 cm in size are benign, periodic monitoring for incremental changes in size, which can be stressful and bothersome to patients, is essential. If relatively easy and safe, an endoscopic method of removal would be optimal treatment. Conventional endoscopic enucleation technically is difficult and often leads to serious complications, such as bleeding and perforation. A novel method for endoscopic enucleation of submucosal tumors with an insulated-tip electrosurgical knife is reported. METHODS: En bloc enucleation was attempted by using an insulated-tip electrosurgical knife in 15 patients (10 men, 5 women; median age 48 years) with submucosal tumors of the esophagus (5) or stomach (5 cardia/fundus, 4 body, one antrum). EUS was performed to determine the layer of origin and the exact size of the submucosal tumor. RESULTS: Tumors arose in the muscularis propria in 11 cases, submucosa in two, and muscularis mucosa in one. Enucleation was relatively easy and successful in 14 cases. In one case, however, piecemeal resection was unavoidable because of fibrotic adhesions with the surrounding tissue; this tumor later was confirmed to be a glomus tumor. Median procedure time was 35 minutes (8-180 minutes) and median size of the submucosal tumors was 2x1.7 cm. The largest lesion, located in the esophagus, measured 6x3 cm. Histopathologic diagnoses included leiomyoma (9), GI stromal tumor (4), stromal tumor of unknown malignant potential (1), and glomus tumor (1). A small perforation occurred in one patient with a 2.5-cm tumor in the anterior wall of proximal gastric body but was managed successfully by endoscopic clip application. Follow-up endoscopy at 2 months in this patient revealed no tumor recurrence and complete healing of the treatment-related ulcer. CONCLUSIONS: En bloc endoscopic enucleation of submucosal tumors by using an insulated-tip electrosurgical knife appears to be safer, easier, and less time consuming compared with previously described methods. However, further investigation and comparative studies are required to confirm the safety and efficacy of this method. 相似文献
20.
Endoscopic resection is an effective treatment for subepithelial tumors arising from the muscularis propria layer of the stomach. However, the invasion pattern revealed by the pathological examination of tumor specimens is often not consistent with the findings of preprocedural endoscopic ultrasounds (EUS).We compared the real growing patterns of tumors, as evaluated on histopathological examination, with their EUS images, and analyzed the outcomes of endoscopic resections in relation to the EUS findings.From January 2006 to June 2015, 32 patients underwent endoscopic resection for gastric tumors originating from the muscularis propria at our hospital.We divided the patients into 3 groups according to the location of the tumor as diagnosed using pre procedural EUS: submucosa (group I, n = 5), muscularis propria (group II, n = 14), and tumors extending into the outer cavity (group III, n = 13).Histopathological examination revealed 15 patients with gastrointestinal stromal tumors (GISTs), 14 with leiomyomas, and 3 with schwannomas. Accuracy of EUS in evaluating tumor invasion was 56%. Some tumors in groups I and II was removed by endoscopic submucosal dissection only. Muscular dissection was needed in 10 patients (71%) in group II and 9 patients (69%) in group III. Four patients (31%) in group III were found to have subserosal tumors. The complete resection rate was 88% (23 patients) among patients who underwent endoscopic submucosal dissection and endoscopic muscular dissection, and 67% (4 patients) among patients who underwent endoscopic subserosal dissection (ESSD). The tumor was completely removed in 12 patients (86%) in group II and 10 patients (77%) in group III.EUS accurately predicts the layer of the subepithelial tumor in the stomach; however, the pattern of invasion of surrounding structures is difficult to evaluate using EUS. 相似文献