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Aim: To investigate the diagnostic accuracy of endoscopic ultrasonography (EUS) for rectal neuroendocrine neoplasms (NENs) and the differential diagnosis of rectal NENs from other subepithelial lesions (SELs)., Methods: The study group consisted of 36 consecutive patients with rectal NENs histopathologically diagnosed using biopsy and/or resected specimens. The control group consisted of 31 patients with homochronous rectal non-NEN SELs confirmed by pathology. Epithelial lesions such as cancer and adenoma were excluded from this study. One EUS expert blinded to the histological results reviewed the ultrasonic images. The size, original layer, echoic intensity and homogeneity of the lesions and the perifocal structures were investigated. The single EUS diagnosis recorded by the EUS expert was compared with the histological results., Results: All NENs were located at the rectum 2-10 cm from the anus and appeared as nodular (n = 12), round (n = 19) or egg-shaped (n = 5) lesions with a hypoechoic (n = 7) or intermediate (n = 29) echo pattern and a distinct border. Tumors ranged in size from 2.3 to 13.7 mm, with an average size of 6.8 mm. Homogeneous echogenicity was seen in all tumors except three. Apart from three patients (stage T2 in two and stage T3 in one), the tumors were located in the second and/or third wall layer without involvement of the fourth and fifth layers. In the patients with stage T1 disease, the tumors were located in the second wall layer only in seven cases, the third wall layer only in two cases, and both the second and third wall layers in 27 cases. Approximately 94.4% (34/36) of rectal NENs were diagnosed correctly by EUS, and 74.2% (23/31) of other rectal SELs were classified correctly as non-NENs. Eight cases of other SELs were misdiagnosed as NENs, including two cases of inflammatory lesions and one case each of gastrointestinal tumor, endometriosis, metastatic tumor, lymphoma, neurilemmoma, and hemangioma. The positive predictive value of EUS for rectal NENs was 80.9% (34/42), the negative predictive value was 92.0% (23/25), and the diagnostic accuracy was 85.1%., Conclusion: EUS has satisfactory diagnostic accuracy for rectal NENs with good sensitivity, but unfavorable specificity, making the differential diagnosis of NENs from other SELs challenging.

Background and Aim: To investigate the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes (MUP) for the diagnosis and treatment of esophageal leiomyoma., Methods: A total of 229 patients with esophageal leiomyoma, diagnosed using EUS, with 12-MHz MUP and a double-cavity electronic endoscope, were enrolled. The clinical characteristics of the patients were analyzed, and those who had therapeutic indications received endoscopic resection or surgical excision. Postoperative histological diagnostic results were compared with the preoperative diagnosis of EUS. All patients, including those with or without endoscopic resection or surgical excision were periodically followed up with EUS., Results: Of the 229 patients, 118 received endoscopic resection, and seven received surgical excision. Postoperative histology showed that 110 patients were completely consistent with the preoperative diagnosis of EUS, and the diagnostic accuracy of EUS was 88.6%. No treatment-related complications occurred among the patients who received endoscopic resection or surgical excision, and no recurrence was observed during the follow-up examinations., Conclusions: Esophageal leiomyoma is a benign tumor of the esophagus. EUS is a useful technique for the diagnosis of esophageal leiomyoma and for making treatment-related decisions., (© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.)

Objective: To examine the values of endoscopic ultrasonography (EUS) on diagnosis and treatment of esophageal hamartoma., Methods: We compared and analyzed various kinds of imaging examinations such as barium esophagram, contrast-enhanced computed tomography (CT) and conventional gastroscopy in retrospectively reviewing the clinical data of an esophageal hamartoma patient seen in our clinic in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Having received various imaging examinations, this patient was finally diagnosed with esophageal hamartoma and underwent gastroscopic resection of hamartoma with the diagnostic information obtained from EUS. The patient had been regularly followed up for 13 months after treatment., Results: Barium esophagram, CT and conventional gastroscopy detected the lesion, but were unable to distinguish it from common esophagopolypus and other submucosal lesions, and unable to determine etiopathogenisis. EUS detected the hamartoma and identified its internal structure, echo, exact size, depth of invasion, origin and the relationship between adjacent tissues and organs, differentiating the lesion from other submucosal tumors and clearly defining the diagnosis. EUS-guided fine needle aspiration (FNA) also helped to identify the etiological diagnosis., Conclusion: EUS was superior to other imaging means in diagnosis and treatment of hamartoma.

Background and Aim: Gastrointestinal mesenchymal tumors (GIMTs) are tumors which arise from mesenchymal cells other than lymphocytes or epithelial cells and include gastrointestinal stromal tumors (GISTs), smooth muscle tumors, neurogenic tumors, fibroblast tumors, and liparomphalus. Here, we studied the clinicopathologic characteristics of GIMTs and determined the diagnostic value of endoscopic ultrasonography (EUS) in GIMTs., Methods: The morphological characteristics of 415 GIMT cases were observed using light microscopy. The expression of CD117, CD34, smooth muscle actin (SMA), S-100, and Ki-67 were detected using immunohistochemistry. EUS results were retrospectively analyzed in 76 cases., Results: Among the 415 GIMT cases, there were 229 GIST cases, 178 smooth muscle tumor cases, and eight neurogenic tumor cases. Diffuse strong expression of CD117 was observed in 202 (88.2%) GISTs and strong expression of CD34 was observed in 135 (59.0%) GISTs. SMA and S-100 expression was detected in smooth muscle tumors (leiomyomas/leiomyosarcoma) and neurogenic tumors, respectively. Of the 12 cases with GISTs, nine cases with positive ki-67 expression and accompanied with more mitosis were pathologically diagnosed as malignant GISTs. Most of the borderline and malignant tumors were found in male patients. EUS was 98.7% accurate in determining GIMT locations, 82.9% accurate in diagnosing GIMTs, and 80.3% accurate in differentiating benign from malignant tumors., Conclusions: GISTs, rather than leiomyomas, are the most common GIMTs. Immunohistochemical markers, such as CD117, CD34, SMA, and S-100, can differentiate GISTs from smooth muscle and neurogenic tumors. The expression of Ki-67 in patients with significant karyokinesis supports a malignant tumor diagnosis. EUS is an accurate method for detecting GIMTs and differentiating between benign and malignant tumors. Use of endoscopic ultrasound-guided fine-needle aspiration biopsies may enable clinicians to make more accurate diagnoses than currently used methods.

Aim: To investigate the clinical value of miniature ultrasonic probes (MUPs) for the diagnosis and treatment of digestive tract diseases., Methods: Endoscopic ultrasonography (EUS) was performed for patients with its indications with 7.5-20 MHz MUPs and double-cavity electronic endoscope. According to the diagnosis of MUPs, patients who had indications of treatment received endoscopic resection or surgical excision. Postoperative histological results were compared with the preoperative diagnosis of MUPs. A few patients without endoscopic resection or surgical excision were periodically followed up with MUPs., Results: A total of 537 patients were examined by MUPs, of them, 256 were diagnosed with gastrointestinal submucosal lesions, 146 with pseudo-submucosal lesions, 50 with digestive tract cancers, 17 with peptic ulcer, 11 with cholecystolithiasis, 8 with chronic pancreatitis, and 2 with achalasia and 47 were diagnosed as normal. After MUPs examinations, 220 patients received endoscopic resection or surgical excision, and the postoperative histological results of 211 patients were completely consistent with the preoperative diagnosis of MUPs. The diagnostic accuracy of MUPs was 95.9%. The result of follow-up with MUPs indicated that gastrointestinal leiomyoma, lipoma, phlebangioma and cyst were unchanged within 1-2 years. The patients who received endoscopic resection or centesis did not have any complications., Conclusion: MUPs are of value in diagnosing gastrointestinal submucosal lesions, staging of digestive tract cancers and biliary-pancreatic diseases. They play a very important role in making therapeutic plans.

Objective: To investigate the clinical value of miniature ultrasonic probes (MUP) in the diagnosis and treatment of digestive tract diseases., Methods: 537 patients who were indicated for endoscopic ultrasorography (EUS) underwent EUS with 7.5 - 20 MHz MUP and double-cavity electronic endoscope. According to the diagnoses of MUP, those patients who presented the indication of treatment were treated by endoscopic resection or surgical excision respectively, the postoperative histological results were compared with the preoperative diagnoses of MUP. A follow-up with MUP was periodically made for a few patients without endoscopic resection or surgical excision., Results: Among the 537 patients the diagnosis of gastrointestinal submucosal lesions was made in the 256 cases, polyp in 56 cases, inflammatory prominence in 37 cases, extrinsic compression 53 cases, digestive tract cancer 50 cases, peptic ulcer 17 cases, cholecystolithiasis 11 cases, chronic pancreatitis in 8 cases, and achalasia 2 cases and 47 cases were diagnosed as normal, After examination of MUP, 220 patients were treated by endoscopic resection or surgical excision respectively, the postoperative histological results of 211 patients were completely consistent with the preoperative diagnosis of MUP, and diagnostic accuracy of MUP was 95.9%. The result of follow-up with MUP indicated that gastrointestinal leiomyoma, lipoma, phlebangioma and cyst were unchanged within 1 - 2 years. The patients who were treated by endoscopic resection or centesis showed no complication., Conclusion: EUS with MUP is a valuable method in diagnosis of gastrointestinal submucosal lesions, staging of digestive tract cancer and diagnosis of biliary-pancreatic diseases. It plays a very important role for making scientific, effective, safe and economic therapeutic plan.

Aim: To investigate the clinical pathologic features of gastrointestinal leiomyoma and the diagnostic value of endoscopic ultrasonography (EUS) on gastrointestinal leiomyoma., Methods: A total of 106 patients with gastrointestinal leiomyoma diagnosed with EUS were studied. The location, size and layer origin of gastric and esophageal leiomyomas were analyzed and compared. The histological diagnosis of the resected specimens by endoscopy or surgery in some patients was compared with their results of EUS., Results: The majority of esophageal leiomyomas were located in the middle and lower part of the esophagus and their size was smaller than 1.0 cm, and 62.1 % of esophageal leiomyomas originated from the muscularis mucosae. Most of the gastric leiomyomas were located in the body and fundus of the stomach with a size of 1-2 cm. Almost all gastric leiomyomas (94.2 %) originated from the muscularis propria. The postoperative histological results of 54 patients treated by endoscopic resection or surgical excision were completely consistent with the preoperative diagnosis of EUS, and the diagnostic specificity of EUS to gastrointestinal leiomyoma was 94.7 %., Conclusion: The size and layer origin of esophageal leiomyomas are different from that of gastric leiomyomas. Being safe and accurate, EUS is the best method not only for gastrointestinal leiomyoma diagnosis but also for the follow-up of patients.