The use of endoscopic ultrasonography in the detection and differentiation of pathology in the wall of the upper gastrointestinal tract

Introduction

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.

Aim

To assess the usefulness of endosonography (EUS) in the differentiation between compression from the outside and intramural lesions of the upper gastrointestinal tract.

Material and methods

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.

Results

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% (p < 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.

Conclusions

Endosonography exceeds computed tomography in differentiating compression from the outside and intramural lesions of the upper gastrointestinal tract.

Laparoscopic surgery assisted by colonoscopy for a submucosal cecal fecalith presenting as acute appendicitis: A case report

RATIONALE

A cecal submucosal fecalith is extremely rare and is likely to be misdiagnosed as appendicitis with an incarcerated fecalith.

PATIENT CONCERNS

This review presents the case of a female patient complaining of recurrent abdominal pain in the right lower quadrant, similar to the clinical symptoms of appendicitis. Physical examination revealed an abdominal tenderness in the right lower quadrant without rebound tenderness or muscular tension. An ultrasound examination found a mass located in the right lower abdomen. Computed tomography showed a high-density shadow in the cecal cavity.

DIAGNOSES

A fecalith was detected in the submucosal cecal wall. The postoperative pathologic examination showed that the fecalith was located in the submucosa.

INTERVENTIONS

A partial cecal excision was performed under laparoscopic surgery assisted by colonoscopy.

OUTCOMES

The patient was discharged 1 week after surgery without postoperative complications.

LESSONS

Fecaliths should be considered in the differential diagnosis of submucosal occupying lesions of the cecum.

Clinical value of miniprobe sonography for detection of esophageal submucosal lesions

OBJECTIVES

The purpose of this study was to evaluate the clinical value of catheter-based miniprobe sonography for diagnosis of esophageal submucosal lesions.

METHODS

A total of 199 patients with esophageal submucosal lesions underwent miniprobe sonography via gastroscopy. The sonograms were reviewed, and the sonographic findings were compared with pathologic findings from specimens obtained by endoscopic or surgical dissection.

RESULTS

The diagnoses for the 199 patients were as follows: 54 cysts, 58 leiomyomas, 25 stromal tumors, 26 venous aneurysms, 15 lipomas, and 21 extramural compressions. A total of 145 lesions were verified by surgery and pathologic examinations. The results for 139 lesions were confirmed by miniprobe sonography; 6 lesions were misdiagnosed. The diagnostic accuracy rate for miniprobe sonography was 95.9%.

CONCLUSIONS

Miniprobe sonography can provide precise information about the size, location, border, and echogenicity of esophageal submucosal lesions. It has high diagnostic accuracy. Preoperative miniprobe sonography via gastroscopy may play an important role in the choice of therapy for esophageal submucosal lesions.