Sun Siyu, Ge Nan, Wang Sheng, Liu Xiang, Lü Qingjie
Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang, China.
Gastrointest Endosc. 2009 Mar;69(3 Pt 1):492-6. doi: 10.1016/j.gie.2008.05.025. Epub 2009 Jan 10.
Duodenal GI stromal tumors (GISTs), with potential for malignant transformation, arise in muscularis propria. It is difficult to endoscopically resect lesions in the muscularis propria by using standard electrosurgical techniques.
Our purpose was to investigate the efficacy of a new method for resection of these tumors, EUS-assisted band ligation.
Prospective study.
Shenjing Hospital of China Medical University.
Nineteen elderly or high surgical risk patients with small duodenal GISTs.
A standard endoscope with a transparent cap attached to the tip was used. The cap was placed over the lesion, maximum sustained suction was applied, and an elastic band was released around the base. EUS was used to determine whether the hypoechoic mass was confined completely by the band.
Beginning 2 weeks after banding, the lesions were observed endoscopically once per week until healing was complete. Thereafter, all patients underwent EUS every 2 to 3 months on schedule.
The tumors sloughed completely. The mean time required for complete healing after band ligation was 4.7 weeks. Bleeding occurred in 2 patients 7 days after ligation because the lesion sloughed. The bleeding was self-limiting and not life threatening. No perforation or other complications occurred. Follow-up ranged from 18 to 63 months, during which time no recurrence was observed.
New technique with limited data.
EUS-assisted band ligation with systematic follow-up by EUS is an effective and safe treatment for small duodenal GISTs.
十二指肠胃肠道间质瘤（GISTs）起源于固有肌层，具有恶性转化的潜能。使用标准电外科技术在内镜下切除固有肌层的病变很困难。
我们的目的是研究一种切除这些肿瘤的新方法——超声内镜引导下套扎术的疗效。
前瞻性研究。
中国医科大学附属盛京医院。
19例患有小十二指肠GISTs的老年患者或手术风险高的患者。
使用顶端附有透明帽的标准内镜。将透明帽置于病变上方，施加最大持续吸力，并在基底部释放弹性圈套。使用超声内镜确定低回声肿块是否完全被圈套包围。
套扎后2周开始，每周进行一次内镜观察，直至愈合完全。此后，所有患者按计划每2至3个月接受一次超声内镜检查。
肿瘤完全脱落。套扎后完全愈合所需的平均时间为4.7周。2例患者在套扎7天后因病变脱落而出血。出血为自限性，无生命危险。未发生穿孔或其他并发症。随访时间为18至63个月，在此期间未观察到复发。
新技术，数据有限。
超声内镜引导下套扎术并通过超声内镜进行系统随访是治疗小十二指肠GISTs的一种有效且安全的方法。
