Hyperechoic demarcation line between a tumor and the muscularis propria layer as a marker for deciding the endoscopic treatment of gastric submucosal tumor

Abstract

Minimally invasive endoscopic resection has been rapidly adopted as a new technique for treating patients with gastric submucosal tumors (SMTs) originating in the muscularis propria (MP) layer. This study was conducted to evaluate the information obtained from endoscopic ultrasonography (EUS) to determine the appropriate endoscopic dissection method for treating SMTs originating in the MP layer. Between February 2014 and May 2016, a total of 50 patients with gastric SMTs originating in the MP layer were enrolled in this study. The clinical features of the patients and their endoscopic, EUS, and histopathologic findings, as well as their postoperative follow-up data, were analyzed in this retrospective study. The mean age of the patients was (55.0±10.2) years, and the male/female ratio was 17:33. Endoscopic submucosal dissection (ESD) was performed on 43 patients and an endoscopic full-thickness resection (EFR) was performed on seven patients. The most frequent location for an SMT was in the upper body region of the stomach (n=16), and the most common pathological diagnosis was a gastrointestinal stromal tumor (GIST) (n=32). The overall rates for complete resection were 95.3% (41/43) and 100.0% (7/7) when the SMTs were treated by ESD and EFR, respectively. The presence of a complete tumor capsule was significantly associated with a complete resection (P=0.001). Of the cases treated by ESD, nine patients developed perforation, one of whom required laparoscopic surgery. The remaining patients were closed with clips or purse-string sutures. The presence of an MP2-type tumor (P=0.018) and a wide connection with the MP layer (P=0.044) were significantly associated with perforation. A preoperative evaluation of the integrity and the location of a tumor capsule and the length of the tumor connection with the MP layer by EUS can improve the complete resection rate and reduce the occurrence of intraoperative complications. Tumors with a complete capsule originating from the superficial MP layer or with a narrow connection with the MP layer are appropriate candidates for treatment by ESD.

Endoscopic ultrasonography is useful for predicting perforation in the endoscopic resection of gastric submucosal tumors originating from the muscularis propria: a retrospective case-control study

“…A literature search demonstrated that there was still a lack of articles investigating risk factors using EUS images to predict perforation. Zhang et al analyzed 43 patients and found that more SMTs in the perforation group were located in the deep MP and had a length of the muscular connection ≥40% of the tumor capsular semi-circumference; however, they did not perform univariate or multivariate analyses [ 13 ]. Moreover, it was difficult to apply their findings in realistic situations.…”

“…Endoscopic ultrasonography (EUS) is an important technique in the diagnosis of SMTs, as it can provide information on the layer from which the SMTs originate, as well as the size, borderline, and echoes to help evaluate the possible pathology of the SMTs [ 12 ]. Additionally, it can show information on the membrane integrity, spatial relationship between the tumor capsule and the serosal layer, and other factors that predict procedural complications and patients’ prognoses [ 13 ]. Zhang et al [ 13 ] showed that SMTs located in the superficial MP with a length of the muscular connection <40% of the tumor capsular semi-circumference may have a lower risk for perforation.…”

“…Additionally, it can show information on the membrane integrity, spatial relationship between the tumor capsule and the serosal layer, and other factors that predict procedural complications and patients’ prognoses [ 13 ]. Zhang et al [ 13 ] showed that SMTs located in the superficial MP with a length of the muscular connection <40% of the tumor capsular semi-circumference may have a lower risk for perforation.…”

Endoscopic ultrasonography is useful in the diagnosis and treatment of rectal neuroendocrine neoplasms: a case series

“…In recent years, rectal NENs are increasingly frequently detected, with the widespread availability and accessibility of endoscopy and cross-sectional imaging modalities (Kos-Kudla et al, 2017). Multiple studies have shown that endoscopic ultrasound (EUS) is an advanced endoscopic technique and is currently used in the diagnosis and preoperative assessment of NENs (Kim, 2012;Liu et al, 2013;Zhang et al, 2017). However, EUS imaging of rectal NEN and differential diagnosis with other submucosal tumors (SMTs) has not been adequately reported.…”

Risk factors and drug resistance in early-onset neonatal group B streptococcal disease

“…However, no penicillin resistance was found in this study, suggesting that the TEM gene may not be the major cause of the GBS resistance to penicillin. Finally, the ermB and mefA genes (Harimaya et al, 2007), which are closely related to the TetM gene for tetracycline resistance (Fischer et al, 2013), are worthy of further studies and may be associated with tumors (Hao et al, 2017;Zhang et al, 2017).…”