超声内镜引导下细针穿刺对上消化道邻近组织肿瘤的诊断价值

目的探讨纵轴超声内镜引导下细针穿刺活检(EUS-FNA)对诊断上消化道邻近组织肿瘤的价值。方法26例上消化道邻近组织可疑肿瘤患者行纵轴EUS-FNA,进行细胞学及组织学检查与经手术病理最终诊断结果相比较,评价纵轴EUS-FNA诊断准确性及安全性。结果22例患者获得足够的细胞或组织学资料,穿刺成功率84.6%。在所有穿刺病例中,EUS-FNA敏感性84.0%,特异性100%;而在穿刺成功的病例中,敏感性达到95.5%,特异性100%。所有患者未出现严重并发症。结论纵轴EUS-FNA对诊断上消化道邻近组织肿瘤特异性高,是安全、有效的方法。     

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。     

Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions

BACKGROUND AND STUDY AIMS: It is still difficult to differentiate reliably between benign and malignant biliary tract lesions. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has added to the diagnostic power of EUS for other gastrointestinal tumors. A retrospective analysis of experience with FNA sampling of bile duct lesions was therefore carried out. PATIENTS AND METHODS: All EUS-FNA procedures for bile duct masses or strictures were analyzed at our tertiary referral center from May 2000 through October 2002. Data for EUS findings, the results of EUS-FNA, and tissue sampling at surgery were included. EUS-FNA procedures were carried out using a 22-gauge needle. An experienced cytopathologist was present during FNA in all but three cases. Clinical follow-up details were recorded when available for patients in whom a suitable diagnostic gold standard was not available for comparison. RESULTS: A total of 35 patients underwent EUS-FNA of bile duct lesions during the study period. There were no complications. Data for EUS-FNA of bile duct masses or strictures and tissue obtained at surgery were available for 23 patients. If positive cytology at surgical pathology is taken as the gold standard, EUS-FNA has a diagnostic yield for cancer of 100 % (if atypia/inconclusive findings in the FNA sample are regarded as benign). Eleven patients had a definite malignancy on surgical pathology. Of these 11 patients, five had a finding of malignancy on EUS-FNA, giving a sensitivity of 45 % (if FNA cytology reported as atypia/inconclusive is regarded as benign). Twelve patients had findings of no malignancy from tissue obtained at surgery. Of these 12 patients, nine had benign pathology and three had atypia/inconclusive findings in the EUS-FNA sample (specificity of 100 % if atypia/inconclusive findings are considered benign). A further 12 patients did not have surgical specimens for comparison with EUS-FNA results. Four patients had definite findings of malignancy on EUS-FNA alone, and one patient had FNA findings suspicious for malignancy. Seven patients had negative or equivocal EUS-FNA results. These 12 patients are described but excluded from further analysis, as a gold standard was not available for comparison. However, clinical follow-up data were available for eight of these 12 patients, and in each case the follow-up findings were compatible with previous benign or malignant EUS-FNA findings. CONCLUSIONS: The practice of EUS-FNA has improved the diagnostic yield of EUS. These results suggest that it is a safe and useful procedure for investigating biliary masses or strictures that have hitherto caused considerable diagnostic confusion, especially in patients with negative brush cytology findings. The possibility of false-negative findings remains, but core biopsy needles may improve the situation. The results of further studies are awaited.     

Transgastric endoscopic ultrasound-guided fine-needle aspiration biopsy and flow cytometry of suspected lymphoma of the spleen

BACKGROUND AND STUDY AIMS: Masses in the spleen can be sampled by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) but the diagnosis of lymphoma using EUS-FNA and flow cytometry has not been reported. We report our experience with transgastric EUS-FNA and flow cytometry in the investigation of patients with suspected lymphoma of the spleen. PATIENTS AND METHODS: All patients with splenic lesions that had been detected by computed tomography and who were referred for transgastric EUS-FNA over a 3-year period were enrolled in this study. The tissue obtained by EUS-FNA was evaluated by flow cytometry in all patients. RESULTS: Six patients with splenic masses were enrolled (four men, two women; median age 58.5 years, range 41 - 82 years). The mean size of the short axis of the lesions was 37.8 mm (SD 23.76 mm) and the mean size of the long axis was 45.6 mm (SD 31.72 mm). EUS-FNA was performed successfully in all patients and the tissue obtained was evaluated by flow cytometry. Two patients were diagnosed with lymphoma; no pathology was identified in the other four patients. Lymphoma of the spleen appeared as sharply demarcated echo-poor lesions; benign lesions appeared echo-rich in comparison with the surrounding splenic tissue. The two patients who were diagnosed with lymphoma underwent chemotherapy. Of the four patients in whom no pathology was identified, one patient subsequently underwent splenectomy for evaluation of persistent abdominal pain and was diagnosed with lymphoma; the three other patients had true-negative disease on the evidence of long-term follow-up (mean 8 months; range 6 - 12 months). No complications related to the EUS-FNA procedure were encountered in any patient. CONCLUSIONS: EUS-FNA of spleen masses is a safe technique that aids in the diagnosis of lymphoma when used in conjunction with flow cytometry.     

Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions

BACKGROUND AND STUDY AIMS: It would be desirable to develop minimally invasive methods of tissue diagnosis from lymph nodes as well as solid lesions in the mediastinum. The aim of the present study was to test the combined method of transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the evaluation of mediastinal lesions. PATIENTS AND METHODS: EUS-FNA and EBUS-TBNA were compared in 33 patients, for the staging of lung cancer in patients with an established diagnosis of non-small-cell lung cancer (n = 20) or for diagnosis of a suspicious mediastinal lesion in patients with suspected lung cancer (n = 13). EBUS-TBNA and EUS-FNA were unsuccessful in one patient each. The diagnoses were verified in 28 of the remaining 31 patients either at thoracotomy (n = 9) or during the clinical follow-up (n = 19). RESULTS: A total of 119 lesions were sampled by EUS-FNA (n = 59) and EBUS-TBNA (n = 60). EUS-FNA and EBUS-TBNA demonstrated cancer in 26 and 28 lesions, respectively, and benign cytology in 30 and 28 lesions, respectively. Suspicious cells were found in three and four lesions by EUS-FNA and EBUS-TBNA, respectively. When the 60 EBUS-TBNA samples were compared with the 59 EUS-FNA samples, 11 additional cancer diagnoses and three samples with suspicious cells were obtained by EBUS-TBNA that had not been obtained by EUS-FNA. Conversely, EUS-FNA diagnosed 12 additional cancer diagnoses, one suspicious and one specific benign diagnosis (sarcoidosis) in addition to EBUS-TBNA. With a combined approach (EUS-FNA + EBUS-TBNA) in 28 of the 31 patients in whom a final diagnosis was obtained in the evaluation of mediastinal cancer, 20 patients were found to have mediastinal involvement, whereas no mediastinal metastases were found in eight patients. The accuracy of EUS-FNA and EBUS-TBNA, in combination, for the diagnosis of mediastinal cancer was 100 % (95 % CI, 83 - 100 %). CONCLUSIONS: EUS-FNA and EBUS-TBNA appear to be complementary methods. A combined approach with both EUS-FNA and EBUS-TBNA may be able to replace more invasive methods for evaluating lung cancer patients with suspected hilar or mediastinal metastases, as well as for evaluating unclear mediastinal or hilar lesions.     

获得性免疫缺陷综合征患者临床及结肠黏膜病变特征的研究

目的 对26例获得性免疫缺陷综合征(AIDS)患者的结肠黏膜病变特征进行临床研究.方法 回顾性总结近10年来有结肠镜检查和组织病理学检查的26例AIDS患者的临床资料.结果 26例AIDS患者均有发热和腹泻等症状.其中以发热、咳嗽为首发症状者19例(73.1%),体温最高达39.5℃.以腹痛、腹泻为首发症状7例(26.9%),同时伴有不同程度的里急后重、水样或黏液便,大便3～10次/d;26例患者中有20例(76.9%)有程度不等的口腔溃疡、鹅口疮、咽痛、吞咽困难或胸骨后疼痛等症状,大便潜血和脓血便阳性率高,分别达69.2%(18/26)和57.7%(15/26);结肠镜检查:84.6%(22/26)患者有不同程度病变,其中慢性结肠炎11例,结肠溃疡10例,回盲部恶性淋巴瘤1例;病变部位以直肠及乙状结肠多见,病变波及直肠者,腹泻症状重;组织病理学检查无特异性;病原学检查:16例活检结肠黏膜组织中检出病原体7例(43.8%).结论 发热和腹泻是AIDS的常见症状;AIDS患者结肠病变多见,表现为慢性结肠炎和结肠溃疡,偶见肿瘤;病变波及直肠者,临床症状重;大便潜血阳性或脓血便,多提示肠道有病变.     

Diagnosis of recurrent rectal cancer deep into the vaginal wall by transvaginal endoscopic ultrasound-guided fine needle aspiration

Local recurrent rectal cancer may present with extraluminal lesions. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is good for diagnosis of such an extraluminal lesion. A 51-year-old Asian female was diagnosed with uT3N0M0 rectal adenocarcinoma 31 months ago. She had undergone chemotherapy, radiotherapy and abdominoperineal resection (APR). Eight months ago, colonoscopy and computed tomography (CT) were unremarkable. Carcinoembryonic antigen was 1.1 ng/ml. Pelvic examination revealed a 3 x 2 cm firm soft-tissue mass palpable through the left vaginal wall. EUS revealed a mass in the left lateral vaginal wall measuring up to 21 x 27 mm in cross section without invasion of adjacent pelvic structures. Transvaginal EUS-FNA was performed with a 22-gauge needle. Final cytology confirmed recurrent rectal adenocarcinoma. Subsequent surgery also confirmed a 2.3 cm grade II adenocarcinoma. The tumor focally extended to the inked margin. The uterus and ovary specimen were negative for disease. We herein report a successful role of transvaginal EUS-FNA for early detection of recurrent rectal cancer at the vaginal wall after abdominoperineal resection (APR).     

Endoscopic ultrasound-guided fine-needle aspiration of right adrenal masses: report of 2 cases

OBJECTIVE: Although transgastric endoscopic ultrasound (EUS)-guided biopsy is a safe and accurate method for sampling of the left adrenal gland, only 2 reports describing EUS-guided fine-needle aspiration (FNA) of the right adrenal gland have been published to date. The aim of this series was to report 2 additional successful cases of EUS-FNA of right adrenal masses. METHODS: In this retrospective single-center case series, prospectively updated cytology and EUS databases between January 1997 and September 2007 were reviewed to identify all patients who underwent attempted EUS-FNA of either adrenal gland. Those who underwent EUS-FNA of the right adrenal gland were identified and reviewed. RESULTS: Of 52 consecutive patients who underwent EUS-FNA of either adrenal gland, 2 had attempted biopsy of the right adrenal gland and constituted the study population. The first patient had a history of colon cancer and was found to have a right adrenal mass during workup of jaundice. The second patient also had a history of colon cancer and was found to have an enlarging right adrenal mass and a subcarinal mass during follow-up computed tomography. Endoscopic ultrasound-guided FNA showed a pheochromocytoma in the first patient and metastatic colon cancer in the second patient. No complications were encountered during either procedure. CONCLUSIONS: This series further shows that EUS-FNA of right adrenal masses is feasible and may be an option for sampling of these lesions. Prospective studies comparing EUS with percutaneous FNA of adrenal masses are indicated to help delineate the indications and limitations of each technique.     

Endoscopic ultrasound-guided fine-needle aspiration in the evaluation of gallbladder masses

BACKGROUND AND STUDY AIMS: There are very few data on endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of gallbladder masses. The aim of this study was to assess the utility and safety of EUS-FNA in the evaluation of patients with gallbladder masses. PATIENTS AND METHODS: Six patients who underwent EUS-FNA of gallbladder masses over a 2-year period between 2002 and 2004 were studied retrospectively. Reports of endoscopic ultrasound (EUS) procedures, EUS images, cytology results, and clinical records were reviewed. Abdominal computed tomography (CT) prior to EUS had revealed a definitive gallbladder mass in only one of the six patients and no gallbladder masses were identified in any of the patients who had undergone prior transabdominal ultrasound. RESULTS: At EUS, all the patients were found to have an echo-poor mass arising from the gallbladder wall or within the lumen of the gallbladder. EUS-FNA of the gallbladder masses revealed adenocarcinoma in five patients and benign disease in one patient. After a mean follow-up period of 127 days (range 90 - 187 days), three patients had died, two were undergoing palliative chemoradiotherapy, and one had been confirmed as having chronic cholecystitis at surgery. No complications occurred. CONCLUSIONS: In patients with obstructive jaundice and equivocal ultrasound or CT findings, evaluation of the gallbladder for the presence of a primary malignancy by EUS is useful. In patients with gallbladder masses, EUS-FNA can be performed safely and can help to make a definitive diagnosis.     

Endoscopic ultrasound-guided fine-needle aspiration biopsy of liver lesions: histological and cytological assessment

BACKGROUND AND STUDY AIMS: EUS-guided fine-needle aspiration biopsy (EUS-FNA) is used increasingly for the diagnosis of mediastinal, biliopancreatic, and gastric tumors. However, little is known about EUS-FNA in hepatic lesions and the best method for tissue analysis. We assessed EUS-FNA combined with histological and cytological evaluation in selected patients. PATIENTS AND METHODS: 41 patients (66 +/- 7 years) were prospectively studied, 33 of whom had clinical findings suggestive of liver malignancies. Selection for EUS-FNA was based on an increased risk of bleeding from percutaneous biopsy (coagulopathy, cirrhosis, ascites, aspirin intake; n = 15), presence of small liver tumors < 2 cm (n = 12), or liver lesions found incidentally (n = 14). Transgastric EUS-FNA of lesions located in accessible liver segments was performed using the Hitachi FG-34UX longitudinal echo endoscope and a 22-G aspiration needle. Specimens were submitted separately for standard cytological and histological evaluation. In the case of malignancies, findings at surgery with histological examination, endoscopy, or computed tomography (CT)-guided biopsy of the primary cancer served as reference results (n = 33), while in benign disorders, a combination of imaging studies (Magnetic Resonance Tomography , scintigraphy) and the clinical follow-up, as summarized in the physician's report, was used as reference. RESULTS: EUS-FNA provided appropriate biopsy specimens in 40/41 patients. It was not possible to aspirate sufficient material in one patient. On average, 1.4 needle passes were necessary to obtain sufficient amounts of tissue. With regard to malignancy, the combination of histological and cytological examination had a sensitivity of 94%, specificity of 100%, negative predictive value (NPV) of 78%, and positive predictive value (PPV) of 100%. Tissue diagnoses were in agreement in 27/41 patients (65%). In the remaining patients, only the cytological examination identified six lesions correctly, while the histological assessment was correct in another seven patients. Malignant lesions were correctly identified by cytology in 24/33 (73%) patients, while histology alone was diagnostic for malignancy in 27/33 (82%) patients. When both modalities were combined, 31 out of 33-malignancies (94%) were correctly diagnosed. Minor complications occurred in two patients and consisted of self-limiting local bleeding. CONCLUSIONS: EUS-FNA of liver tumors is a powerful, reliable, and safe procedure for the diagnosis of malignant liver lesions. Optimal diagnostic results are achieved by combining cytological with histological assessment. Hence, EUS-FNA is an alternative to percutaneous biopsy, particularly in patients at risk of bleeding or with small lesions of the liver.     

Utility of Endoscopic Ultrasound (EUS)-Guided Fine-Needle Aspiration for Peri-arterial Soft Tissue Cuffs Without Identifiable Pancreas Mass on CT and EUS: A Prospective Comparative Study

Pancreatic cancer may present as a peri-arterial soft tissue cuff (PSTC) around the superior mesenteric artery or celiac axis without an identifiable pancreatic mass. We evaluated the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with a PSTC without definite pancreas involvement and those with a typical pancreatic mass. The patients who underwent EUS-FNA of a PSTC without pancreatic involvement were prospectively enrolled. The patients who underwent EUS-FNA for a pancreatic mass were recruited as a control group. A total of 224 patients underwent 247 EUS-FNAs. Among the 13 patients with a PSTC, 11 were positive for malignancy as determined by EUS-FNA, with 5 diagnosed after the first session and 6 after the second session. The diagnostic yield of PSTCs by EUS-FNA was significantly lower than that for typical pancreatic masses (65% vs. 87%, p = 0.02). An on-site cytopathologist and repeated EUS-FNA are recommended to improve the diagnostic accuracy of this disease entity.     

经直肠腔内灌注肠道超声造影诊断结直肠占位性病变的价值

目的探讨经直肠腔内灌注肠道超声造影在结直肠占位性病变中的诊断价值。 方法选取可疑结直肠占位性病变的患者196例,每例患者分别接受经直肠腔内灌注超声造影检查和肠道内窥镜检查。以外科手术病理结果作为"金标准",分析比较经直肠腔内灌注超声造影检查和肠道内窥镜检查诊断结直肠占位性病变的准确性。 结果经直肠腔内灌注超声造影观察结肠和直肠的解剖结构和病变特征,发现恶性占位性病变81例,其中结肠癌39例,直肠癌42例;良性占位性病变30例,其中直肠息肉11例,结肠息肉19例。经直肠腔内灌注超声造影探查结直肠占位性病变的位置、数目和>10 mm的病变,其敏感度、特异度、阳性预测值、阴性预测值和准确性,与肠道内窥镜检查比较,均无显著差异。经直肠腔内灌注超声造影检查与肠道内窥镜检查在判断病变位置和数目方面均具有良好的一致性（K值=0.97,0.98）。两者在判断结直肠占位性病变大小方面的一致性因病变大小而不同：对于<5 mm、5~10 mm、>10 mm的结直肠占位性病变的探查,两种检查方法的一致性K值分别为0.82,0.89,0.98,其敏感度、特异度、阳性预测值、阴性预测值和准确性结果也显示在探查微小的（<5 mm）黏膜病变时,肠道内窥镜检查略优于经直肠腔内灌注超声造影检查。在探查经手术证实的周围组织浸润病变时,经直肠腔内灌注超声造影检查明显优于肠道内窥镜检查。 结论经直肠腔内灌注超声造影检查可以有效探查结直肠占位性病变的位置和范围,与肠道内窥镜检查互补性强,其可作为结直肠占位性病变的常规检查方法之一。     

Endoscopic ultrasonography-guided fine-needle cytodiagnosis of mediastinal metastases from renal cell cancer

BACKGROUND: Endoscopic ultrasonography (EUS) has become the investigation of choice for the evaluation of the mediastinum. Lung and mediastinum are amongst the common sites of metastases from renal cell cancer (RCC). We diagnosed metastatic RCC in mediastinal lymph nodes by EUS-guided fine-needle aspiration (FNA) cytology. METHODS: A total of 111 patients with mediastinal lymph nodes had undergone EUS-FNA using a linear array echo endoscope and a 170 cm, 22 G GIP needle consecutively. Smears were prepared, air-dried, and sent to an independent cytologist. RESULTS: Seven patients (all males, mean age 64.8 years, range 45-72) were diagnosed cytologically to have metastatic RCC. Three patients had been diagnosed with RCC in the past (2, 7, and 17 years ago) while in the others, this was primarily diagnosed on the basis of EUS-FNA. The EUS features of these mediastinal RCC metastases include irregular lesions with inhomogenous echotexture, measuring 2.8 cm (median; range 1.0-4.5) located predominantly in the posterior mediastinum. CONCLUSION: EUS-FNA diagnosis of metastatic RCC is safe and feasible. It is especially useful in the evaluation of the mediastinum for suspected metastases. Cytology examination results in combination with clinical features could suggest the site of origin of the primary, assisting in further management.     

结肠内支架治疗乙状结肠癌、直肠癌梗阻

目的探讨结肠内支架治疗直肠癌、乙状结肠癌梗阻的疗效和意义。方法2001年至今，对22例直肠癌、乙状结肠癌梗阻的患者进行了结肠内支架治疗。10例尚能手术的患者行暂时性支架治疗，12例不能手术的患者行永久性支架治疗。结果22例结肠内支架置入均获成功，解决了患者的肠道梗阻问题，未出现严重合并症。结论结肠内支架无论作为直肠癌、乙状结肠癌术前梗阻解除或用于解决复杂直肠癌梗阻，均能达到解决梗阻、改善生活质量的效果，有一定的应用前景。     

Ultrasonically guided fine-needle aspiration biopsy of gastrointestinal mass lesions.

Ultrasonically guided fine-needle aspiration biopsy was performed in 78 patients with ultrasonically demonstrable typical gastrointestinal mass lesions. Of these patients, 61 later proved to have malignant lesions (18 in the stomach, three in the small intestine, and 40 in the colon or rectum), and 17 had benign lesions. In 50 of 61 cases of malignant lesions, the cytologic diagnosis was positive for cancer. There were no false positives. It is concluded that when a structure with the ultrasonic characteristics of a gastrointestinal mass lesion is disclosed, fine-needle aspiration biopsy can safely and conveniently differentiate between malignant and benign lesions in most cases. The ultrasonically guided biopsy is suggested as an alternative to endoscopically guided biopsy.     

水灌肠18F-FDG PET/CT鉴别诊断良恶性结直肠病变

目的 探讨水灌肠PET/CT鉴别结直肠良恶性病变的价值。方法 对常规PET/CT检查发现的45例直肠及乙状结肠局灶性或弥漫性FDG浓聚患者行水灌肠PET/CT显像,与肠镜或术后病理结果进行对照。结果 水灌肠PET/CT扫描后诊断生理性摄取准确率为100%（15/15）;诊断恶性肿瘤的敏感度为100%（18/18）,特异度为92.59%（25/27）,准确率为95.56%（43/45）,阳性预测值为90.00%（18/20）,阴性预测值为100%（27/27）。结论 水灌肠PET/CT可有效排除结直肠生理性摄取¹⁸F-FDG,准确鉴别常规PET/CT难以诊断的良恶性结直肠病变。     

Hydrocolonic sonography in the evaluation of colonic lesions

BACKGROUND: The present study was done to assess the sensitivity, specificity, ease of examination, and limitations of hydrocolonic sonography (HCS) to evaluate a heterogeneous spectrum of colonic disorders. METHODS: In a prospective study, 100 patients (53 male, 47 female) with clinical suspicion of colonic abnormality were examined by conventional abdominal sonography, HCS, and colonoscopy on the same day. The patients then underwent appropriately planned barium studies. Histopathologic diagnosis was established by colonoscopic/excision biopsies or fine needle aspiration cytology (FNAC) whenever indicated and results correlated. RESULTS: In 94% of patients, it was possible to evaluate the entire colon from the rectosigmoid junction to the cecum. Redundant parts of the colon were not well evaluated by this technique. The rectum could not be adequately evaluated, and rectal examination was not included in the study. HCS can evaluate in great detail both the colonic lumen and wall and, hence, could suggest the nature of the lesion in the majority (87.9%) of cases based on characteristic changes in wall stratification, echogenicity, lumenal changes, and site and length of involvement, although distinguishing between benign and malignant lesions was not always possible. In 93% of patients with tuberculous colitis/ileocolitis, the normal wall stratification was no longer in evidence, with moderate hypoechoic thickening of the wall (average = 8.34 mm). Malignant lesions (93.7%) showed grossly thickened bowel wall with loss of stratification and hypoechoic/heterogeneous echo texture. Intralumenal polypoid masses also were seen in 87.5% of cases, and there was extension beyond the adventitia and involvement of pericolonic tissues in 75% of cases. All patients with ulcerative colitis had only mild hypoechoic wall thickening; the five-layer structure could be clearly discerned in 87.5% of cases. HCS had an overall sensitivity of 90.9% and a specificity of 94.7% in this study. CONCLUSIONS: HCS can be advantageously used for diagnosis and differential diagnosis of inflammatory and malignant colonic lesions and also for follow-up of patients with chronic inflammatory large bowel diseases such as ulcerative colitis.     

Angiodysplasia in the colon and rectum. Endoscopic morphology, localisation and frequency

In a prospective study, the occurrence of angiodysplasia was investigated by total colonoscopy in 1938 patients. Angiodysplasia was found in 59 patients, i.e. 3%. 12 out of 59 patients were admitted for acute or chronic peranal hemorrhage or anemia. 47 out of 59 patients were asymptomatic. The site of the lesions was as follows: cecum 37%, ascending colon 17%, transverse colon 7%, descending colon 7%, sigmoid colon 18% and rectum 14%. Histological confirmation was obtained in 15 out of 37 biopsies. The endoscopic appearance was variable, most of the vascular dilatations being smaller than 5 mm (n = 47), with a homogeneous (n = 35) or inhomogeneous (n = 24) structure and a regular (n = 34) or irregular (n = 25) border. The lesions were single (n = 34) as well as multiple (n = 25), they were usually flat (n = 54), seldom slightly prominent (n = 5). Concomitant pathological findings in the bowel were diagnosed in 33 out of 59 patients: diverticula in 32%, adenomas in 24% and carcinomas in 8.5%. Right hemicolectomy for bleeding angiodysplasia is indicated only if endoscopic therapy has failed and other colorectal sources of bleeding, and especially angiodysplasia in the left colon and rectum have been excluded by endoscopy or angiography.     

超声内镜在食管结核诊断中的9例应用并文献复习

目的总结食管结核超声内镜(EUS)声像图特征及其他临床资料结果,提高该病的诊断率。方法回顾性分析该院2011年6月-2016年5月经EUS检查或内镜超声引导下细针穿刺活检(EUS-FNA)而确诊为食管结核的9例患者的临床资料,并复习国内外文献。结果 9例患者中,表现为吞咽梗阻6例,胸骨后疼痛3例,伴有盗汗、低热症状2例,伴咳嗽、咯血1例,伴咽痛1例;病变位于食管中段7例(77.78%),上段1例,食管下段合并咽部病变1例;8例为隆起型病变,其中4例表面破溃,1例呈息肉样隆起,另1例为溃疡并憩室型病变;内镜下活检6例中5例确诊,其中3例活检2次;EUS表现为食管壁内不均质低回声占位,边界模糊,内见高回声光斑,侵及黏膜下层或全层,部分病灶突破外膜层与壁外肿大淋巴结融合贯通;2例行EUS-FNA穿刺,病理发现炎性肉芽肿,考虑结核;均予以抗结核治疗后症状缓解。结论食管结核临床表现主要为吞咽困难,好发于食管中段,内镜下表现主要为隆起型和溃疡型病变,通过多次内镜下活检,结合EUS特征或EUS-FNA穿刺病理学检查能明显提高该病的诊断率,减少误诊率。     

内镜超声检查在上消化道隆起性病灶诊断中的应用——附322例诊断分析

目的：探讨内镜超声检查在上消化道隆起性病灶诊断中的价值。方法：应用OLYMPUS EU-M30，GF-UM200型；7.5/12MHz超声内镜对322例内镜提示上消化道隆起性病灶，部分甚至结合活检仍、无法确诊者进行内镜超声检查，并分析检查结果，结果：322例上消化道隆起性病灶中，以胃的隆起性病灶最多（198例），其他依次为食道（95例），十二指肠（23例）和贲门（6例）。病变性质以良性病变为，共检出平滑肌瘤121例（位于固有肌层83例，黏膜肌层38例），其它依次为恶性肿瘤53例，外压性病变50例（其中胃底20例，脾脏外压14例），未发现病变23例，异位胰腺20例（胃窦15例），血管性病变16例，息肉11例，炎症9例，消化道壁增厚8例，嗝 肿与脂肪瘤各5例，纤维瘤1例。恶性病变及部分良性病变获组织学证实。结论：内镜超声检查能贴近病变部位进行扫描。能清楚地显示消化道壁的层次结构。对上消化道隆起性病灶具有准确的定位作用，并能较好的提示病变的性质，对明确上消化道隆起性病灶的诊断及指导治疗，具有较高的价值。但在肌瘤的良恶性判断上存在着一定的困难。