Chien Cheng-Hung, Chien Rong-Nan, Yen Cho-Li, Fang Kua-Meen, Liu Ching-Jung, Lin Chih Lang, Chang Jia-Jang, Chen Li-Wei, Lee Tsung-Shih, Chen Shuo-Wei, Hu Ching-Chih, Chang Liang-Che
Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2010 Jan-Feb;33(1):73-81.
Endoscopic ultrasonography (EUS) has often been used to evaluate gastric subepithelial masses (SEM) and their malignant potential. Information on the use of EUS to survey small gastric SEM is limited.
A total of 125 consecutive patients referred for evaluation of a suspected gastric SEM were evaluated by EUS from February 2002 to February 2008. Periodic surveillance using EUS or upper gastrointestinal endoscopy was routinely advised. Surgical treatment was considered if a malignant tumor was suspected or symptomatic.
In the 125 patients, EUS found 23 (18.4%) cases of extraluminal compression, 70 (56%) gastrointestinal stromal tumors (GISTs), 9 (7.2%) cases of ectopic pancreas, 5 (4.0%) mucosal tumors, 3 (2.4%) cases of varices, 2 (1.6%) cysts, 2 (1.6%) lipomas, 1 (0.8%) mucosal polyp, 1 (0.8%) submucosal tumor, 6 (4.8%) patients with no abnormality, and 3 (2.4%) unidentified lesions. Surgery was performed in 15 patients, revealing GISTs in 10 patients, and gastrointestinal autonomic nervous tumors (GANTs) in 2 patients as well as other malignant lesions in 3 patients. The pathological findings confirmed that 11 (73.3%) of 15 larger tumors (> 30 mm) were accurately diagnosed. Only 1 of 9 suspected GIST (mean initial tumor size 13.4 +/- 8.3 mm, mean follow-up period 23 months), in the EUS surveillance group significantly increased in size, and surgical pathology disclosed a GIST with intermediate malignant potential.
For evaluating gastric SEM, EUS is able to accurately differentiate intramural from extramural lesions and aid in narrowing the differential diagnosis. In this limited case study, most small gastric SEM (< 30 mm) did not exhibit size changes during follow-up. If the tumor size increases or the ultrasonographic features of a tumor suggest malignant possibility during EUS surveillance, surgical resection should be considered.
内镜超声检查（EUS）常用于评估胃黏膜下肿物（SEM）及其恶性潜能。关于使用EUS检查小的胃SEM的信息有限。
2002年2月至2008年2月，对连续125例因疑似胃SEM而转诊评估的患者进行了EUS检查。常规建议使用EUS或上消化道内镜进行定期监测。如果怀疑为恶性肿瘤或出现症状，则考虑手术治疗。
在125例患者中，EUS发现23例（18.4%）管腔外压迫、70例（56%）胃肠道间质瘤（GIST）、9例（7.2%）异位胰腺、5例（4.0%）黏膜肿瘤、3例（2.4%）静脉曲张、2例（1.6%）囊肿、2例（1.6%）脂肪瘤、1例（0.8%）黏膜息肉、1例（0.8%）黏膜下肿瘤、6例（4.8%）无异常患者以及3例（2.4%）病变不明患者。15例患者接受了手术，其中10例为GIST，2例为胃肠道自主神经肿瘤（GANT），3例为其他恶性病变。病理结果证实，15个较大肿瘤（>30mm）中的11个（73.3%）被准确诊断。在EUS监测组中，9例疑似GIST（平均初始肿瘤大小13.4±8.3mm，平均随访期23个月）中只有1例肿瘤大小显著增加，手术病理显示为具有中等恶性潜能的GIST。
对于评估胃SEM，EUS能够准确区分壁内病变和壁外病变，并有助于缩小鉴别诊断范围。在这个有限的病例研究中，大多数小的胃SEM（<30mm）在随访期间未出现大小变化。如果在EUS监测期间肿瘤大小增加或肿瘤的超声特征提示有恶性可能，则应考虑手术切除。
