Varas M J, Miquel J M, Abad R, Espinós J C, Cañas M A, Fabra R, Bargalló D
Unidad de Ecoendoscopia, Centro Médico Teknon, Barcelona, Spain.
Rev Esp Enferm Dig. 2007 Mar;99(3):138-44. doi: 10.4321/s1130-01082007000300004.
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).
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.
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%.
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.
由于适应证不断增加，干预性内镜超声检查的应用越来越广泛。在此，我们介绍我们对内镜超声检查（EUS）用于诊断（EUS-FNA）和治疗（EUS引导下肿瘤切除术和黏膜切除术）的回顾性初步经验（60例手术）。
在一组27例患者中，包括10例黏膜下肿瘤（SMT）、2例腺病和15例潜在胰腺肿瘤（8例胰腺癌），在治疗（主要是手术）前，采用7.5MHz扇形EUS-FNA进行诊断。对一个胰腺假性囊肿进行了引流。在21例有27个SMT的患者中（10例患者有13个类癌），采用标准圈套器或辅助息肉切除术技术并进行黏膜下注射实施肿瘤切除术，少数病例（2例）在7.5、12或20MHz径向EUS检查后使用弹力圈套结扎术。在6例浅表性胃食管癌或胃发育异常患者中，在7.5和20MHz的EUS或MPs检查后进行了内镜黏膜切除术（经典EMR）。对55例有60处病变的患者进行了回顾性分析，其中女性29例，男性26例，平均年龄60岁（30 - 88岁）。
将EUS-FNA结果与标本组织学结果比较时，其诊断准确性（P）、敏感性（S）、特异性（Sp）、阳性预测值（PPV）和阴性预测值（NPV）分别为85%、83%、100%、100%和43%。腺病（100%）和胰腺肿瘤（87%）的P高于SMT（80%）。除1例上消化道出血（UGIB）（3.7%）外未出现并发症，该例发生在胃SMT，经内镜治疗效果满意。在21例患者（10例类癌伴13个肿瘤）组中，27个SMT经内镜肿瘤切除术治疗，无穿孔发生，仅记录到2例UGIB（7.4%），其中1例为自限性。92%的病例内镜切除完整。经典EMR未发生并发症，所有患者仍存活，无局部或远处复发证据。该组完全切除率为100%。
EUS-FNA是一种安全且诊断准确性高的技术。EUS引导下肿瘤切除术和黏膜切除术在内镜治疗这些肿瘤方面也是安全有效的技术。
