Dyrla Przemysław, Gil Jerzy, Niemczyk Stanisław, Saracyn Marek, Kosik Krzysztof, Czarkowski Sebastian, Lubas Arkadiusz
Department of Gastroenterology, Military Institute of Medicine, Warsaw, Poland.
Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
Prz Gastroenterol. 2018;13(1):30-34. doi: 10.5114/pg.2018.74560. Epub 2018 Mar 26.
The growing incidence of gastrointestinal diseases forces to improve imaging techniques. Identification of lesions located inside the wall of intestinal tract or in close proximity often was not possible using endoscopy or computed tomography.
To assess the usefulness of endosonography (EUS) in the differentiation between compression from the outside and intramural lesions of the upper gastrointestinal tract.
For 4 years 20,012 patients with performed gastroscopies were enrolled in the study. One hundred and ninety-nine patients (96 females, 103 males; age 62.2 ±14.1 years) with pathology of the wall of the upper gastrointestinal tract qualified for further diagnosis. Endosonography and computed tomography (CT) were performed in each patient. A chest CT was performed in patients with a lesion in the oesophagus. An abdomen CT was performed in patients with pathology in the stomach or duodenum. Based on the results of EUS, histopathology, and imaging, each patient qualified for treatment, endoscopic observation, surgery, or cancer treatment.
In EUS 129 (64.8%) intramural lesions were identified. Five (2.5%) diagnoses were false negative. In 62 (31.2%) patients no intramural changes were recognised and three (1.5%) results were false positive. The sensitivity and specificity of EUS was 96.3% and 95.4%, respectively, with positive predictive value 90.7%, negative predictive value 97.8%, and overall accuracy 95% ( < 0.05). Endoscopic therapy was performed in 31 (15.6%) patients, and 99 (49.8%) were classified for endoscopic observation. Surgery was performed in 50 (25.1%) patients, and 19 (9.5%) patients required oncologic treatment.
Endosonography exceeds computed tomography in differentiating compression from the outside and intramural lesions of the upper gastrointestinal tract.
胃肠道疾病发病率的不断上升促使成像技术不断改进。使用内窥镜检查或计算机断层扫描往往无法识别位于肠道壁内或紧邻肠道壁的病变。
评估内镜超声检查（EUS）在上消化道外部压迫与壁内病变鉴别诊断中的作用。
在4年时间里，共有20012例接受胃镜检查的患者纳入本研究。199例（96例女性，103例男性；年龄62.2±14.1岁）上消化道壁有病变的患者符合进一步诊断标准。对每位患者均进行了内镜超声检查和计算机断层扫描（CT）。食管有病变的患者进行胸部CT检查。胃或十二指肠有病变的患者进行腹部CT检查。根据内镜超声检查、组织病理学和影像学检查结果，每位患者接受治疗、内镜观察、手术或癌症治疗。
在内镜超声检查中，发现129例（64.8%）壁内病变。5例（2.5%）诊断为假阴性。62例（31.2%）患者未发现壁内改变，3例（1.5%）结果为假阳性。内镜超声检查的敏感性和特异性分别为96.3%和95.4%，阳性预测值为90.7%，阴性预测值为97.8%，总体准确率为95%（<0.05）。31例（15.6%）患者接受了内镜治疗，99例（49.8%）患者被分类进行内镜观察。50例（25.1%）患者接受了手术，19例（9.5%）患者需要进行肿瘤治疗。
在内消化道外部压迫与壁内病变的鉴别诊断方面，内镜超声检查优于计算机断层扫描。
