[Diagnosis and therapy of benign tumors of the esophagogastric junction]

Exploration of a new method for Photoshop-assisted endoscopic ultrasound to distinguish gastrointestinal stromal tumor and leiomyoma

BACKGROUND

Gastrointestinal stromal tumors (GISTs) and leiomyomas (GILs) are difficult to be distinguished by endoscopic ultrasound (EUS). Photoshop software combined with EUS has limitations in distinguishing GIST and GIL by detecting gray values. Therefore, the research aims to explore the new method by Photoshop in distinguishing the features of GISTs from GILs.

METHODS

Patients who underwent EUS and were confirmed as GIST and GIL pathologically were included. The images of EUS were analyzed by Photoshop software. The mean gray value of tumor (Tmean), muscularis propria (Mmean), submucosa (Smean), water (Wmean) and T_SD that originated from the same image, were calculated one by one. Then the ratio of the mean gray value of tumor to muscularis propria (TMratio), submucosa (TSratio), and water (TWratio) were calculated, respectively.

RESULTS

Four hundred seventy-two patients (239 GILs and 233 GISTs) were enrolled in this study retrospectively. All the tumors were located in the stomach. Tmean and T_SD were significantly higher in GISTs than in the GILs group (63.10 ± 23.29 vs. 57.70 ± 22.67, p = .011; 26.24 ± 8.99 vs. 24.30 ± 8.26, p = .015). TMratio, TSratio, and TWratio were also significantly higher in GISTs group (0.97 ± 0.37 vs. 0.81 ± 0.28, p < .001; 0.42 ± 0.14 vs. 0.38 ± 0.12, p < .001; 2.65 ± 1.36 vs. 2.16 ± 1.02, p < .001). The AUC of Tmean was 0.952 (95% CI 0.897-1.000), which can better distinguish GIST from GIL; the sensitivity was 0.900, the specificity was 0.975, and the Youden Index was 0.875, and the cutoff was 79.64. The AUCs of TMratio, TSratio, and TWratio were 0.917 (95% CI 0.844-0.991), 0.897 (95% CI 0.812-0.981), and 0.929 (95% CI 0.8870-0.987), respectively. The aforementioned data was verified in the clinical cases of known results, including 40 GISTs and 40 GILs. The sensitivity of Tmean, TMratio, TSratio, and TWratio for diagnosis of GIL was 97.5%, 82.5%, 95%, and 97.5%, respectively. And they were 62.5%, 95%, 80%, and 92.5% for GIST.

CONCLUSION

The application of Photoshop combined with EUS to detect the gray value and standard deviation has a specific value in distinguishing GIST from GIL, but with some deviation. Applying the gray value ratio also has great discrimination significance and can avoid the differences in operation from different instrument and equipment personnel. Therefore, it is worthy of clinical promotion in the future.

LAPAROENDOSCOPIC TRANSGASTRIC RESECTION OF SUBEPITHELIAL JUXTACARDIAC TUMORS

BACKGROUND

With a prevalence of 0.4-3.5%, subepithelial lesions of the upper digestive tract are discovered during endoscopic procedures. Treatment depends on etiological and pathophysiological information, ability to diagnose and the different technical resources available.

AIM

To demonstrate the effectiveness of a surgical technique that combines endoscopy and videolaparoscopy in the transgastric resection of subepithelial juxtacardic lesions.

METHOD

The patients were assisted with a technical combination between endoscopy and laparoscopy. After diagnosis of subepithelial tumor, intraoperative endoscopy was performed after pneumoperitoneum and placement of laparoscopic tweezers. Through endoscopy, the following steps were performed: demarcation of surgical margins, visualization of the intragastric image for the laparoscopic procedure and removal of the surgical specimen. By laparoscopy the following steps were performed: intragastric intra-abdominal access, resection of the part and closure of the gaps.

RESULTS

This technique was applied in two cases in order to evaluate its initial results. There were two videolaparoendoscopic resections of juxtacardiac gastric tumors of the posterior wall. Both had their endoscopic diagnosis confirmed. After laparoendoscopic and tomographic and/or ecoendoscopic diagnostic complementation and preoperative performance, the laparoendoscopic procedure was indicated. The patients had a good recovery, with a short hospitalization time and no complications.

CONCLUSION

The combined use of videolaparoscopy and endoscopy is a safe and effective technique for transgastric resection of juxtacardiac subepithelial lesions. It may be important for definitive diagnosis of the tumor.