Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
Gastrointest Endosc. 2010 Jan;71(1):188-94. doi: 10.1016/j.gie.2009.07.029. Epub 2009 Oct 30.
There is a growing body of evidence that a pathological diagnosis is necessary for small (<3 cm in diameter), asymptomatic, hypoechoic, subepithelial tumors (SETs) originating from the muscularis propria on EUS. However, the diagnostic efficacy of current tissue sampling techniques appears to be limited.
To evaluate the diagnostic yield and safety of endoscopic partial resection using the unroofing technique (EPR-UT) in a subset of patients.
A prospective case series.
A single tertiary-care referral center.
Between August 2007 and March 2009, 16 patients with hypoechoic SETs of <3 cm in diameter, originating from the muscularis propria on EUS (14 gastric and 2 esophageal lesions), underwent EPR-UT.
The overlying mucosa was removed by using the unroofing technique using a conventional snare with electrical current to expose the tumor sufficiently. Next, the exposed tumor was partially resected by snaring.
The diagnostic yield and safety of this method.
EPR-UT provided specimens that were sufficient for a diagnosis and the assessment of risk for malignancy in 15 out of 16 cases (diagnostic yield 93.7% [95% CI, 80.4%-100.0%]). The pathological diagnoses were leiomyoma (7 of 15, 46.6%), GI stromal tumor (6 of 15, 40.0%), aberrant pancreas (1 of 15, 6.6%), and well-differentiated neuroendocrine carcinoma (1 of 15, 6.6%). Six cases with GI stromal tumor were classified as very low risk for malignant potential (mitotic index <5/50 high-power fields). Procedural blood oozing was relatively common (9 of 16, 56.0% [95% CI, 33.0%-77.0%]); however, this minor complication was easily controlled by argon plasma coagulation. There were no procedure-related major complications (0 of 16, 0% [95% CI, 0.0%-23.0%]).
Single-center, noncomparative study with small sample size.
EPR-UT appears to be simple, safe, and effective for determining the definite pathological diagnosis and assessing malignant potential of small, hypoechoic SETs originating from the muscularis propria on EUS.
越来越多的证据表明，对于起源于超声内镜下黏膜下层的小（直径<3cm）、无症状、低回声、位于黏膜下层的肿瘤（SETs），有必要进行病理性诊断。然而，目前的组织取样技术的诊断效果似乎有限。
评估经内镜部分切除术-掀盖技术（EPR-UT）在部分患者中的诊断效果和安全性。
前瞻性病例系列研究。
单中心三级转诊中心。
2007 年 8 月至 2009 年 3 月期间，16 名直径<3cm、起源于超声内镜下黏膜下层的低回声 SETs 患者（14 例胃病变，2 例食管病变）接受了 EPR-UT 治疗。
采用常规圈套器联合电流去除覆盖的黏膜，以充分暴露肿瘤。然后通过圈套器部分切除暴露的肿瘤。
该方法的诊断效果和安全性。
EPR-UT 提供了足够的标本用于诊断和评估恶性风险，16 例患者中有 15 例（诊断效果 93.7%[95%CI，80.4%-100.0%]）。病理诊断为平滑肌瘤（7/15，46.6%）、胃肠道间质瘤（6/15，40.0%）、异位胰腺（1/15，6.6%）和分化良好的神经内分泌癌（1/15，6.6%）。6 例胃肠道间质瘤被归类为恶性潜能极低（核分裂象<5/50 高倍视野）。手术过程中出血较为常见（16 例中有 9 例，56.0%[95%CI，33.0%-77.0%]）；然而，这种轻微的并发症很容易通过氩等离子凝固术控制。无与操作相关的主要并发症（16 例中无 0 例，0%[95%CI，0.0%-23.0%]）。
单中心、非对照研究，样本量小。
EPR-UT 似乎是一种简单、安全、有效的方法，可用于确定小的、低回声的起源于超声内镜下黏膜下层的 SETs 的明确病理诊断，并评估其恶性潜能。
