Endoscopy 2002; 34(12): 979-983
DOI: 10.1055/s-2002-35839
Original Article

© Georg Thieme Verlag Stuttgart · New York

Transabdominal Ultrasound for Visualizing Gastric Submucosal Tumors Diagnosed by Endosonography: Can Surveillance Be Simplified?

M.  Polkowski 1 , J.  Palucki 2 , E.  Butruk 1
  • 1Dept. of Gastroenterology, Medical Centre for Postgraduate Education, Warsaw, Poland
  • 2Dept. of Radiology, Institute of Oncology, Warsaw, Poland
Further Information

Publication History

Submitted: 24 February 2002

Accepted after Revision: 19 July 2002

Publication Date:
02 December 2002 (online)

Background and Study Aims: Management options for gastric submucosal tumors (SMTs) include tumor removal or surveillance. If the latter is chosen, it requires repeated measurements of the tumor diameter. Although this can be achieved using endoscopy or endosonography (EUS), a less invasive and cheaper method would be welcome. The aim of this prospective study was to assess the proportion of gastric SMTs that can be visualized using transabdominal ultrasound of the water-filled stomach.
Patients and Methods: Fifty-one consecutive patients with endosonographically diagnosed gastric SMTs underwent transabdominal ultrasound examinations of the water-filled stomach performed immediately after EUS; both procedures were carried out by the same investigator. Transabdominal ultrasound was considered positive only if: firstly, the tumor was visualized unequivocally; secondly, its dimensions could be measured; and thirdly, photographic documentation could be recorded. In each case, a positive result had to be confirmed by an independent investigator, who reviewed the photographic documentation.
Results: The median size of SMTs on EUS was 25 mm (range 4 - 55 mm). Twelve tumors were located in the antrum, 25 in the gastric body, and 14 in the gastric fundus or cardia. Transabdominal ultrasound demonstrated the tumor in 35 of 51 patients (69 %). For tumors ≤ 30 mm, the visualization rate was 61 % (22 of 36). The location of the tumor and its EUS features did not significantly affect the sensitivity of transabdominal ultrasound.
Conclusions: In 69 % of patients with endosonographically diagnosed gastric SMTs, the tumor can also be visualized (and measured) using transabdominal ultrasound of the water-filled stomach. This noninvasive and inexpensive method may potentially be useful for surveillance in patients with SMTs, and further evaluation in this setting is warranted.

References

  • 1 Hedenbro J L, Ekelund M, Wetterberg P. Endoscopic diagnosis of submucosal gastric lesions: the results after routine endoscopy.  Surg Endosc. 1991;  5 20-23
  • 2 Caletti G C, Brocchi E, Ferrari A. et al . Guillotine needle biopsy as a supplement to endosonography in the diagnosis of gastric submucosal tumors.  Endoscopy. 1991;  23 251-254
  • 3 Rösch T. Endoscopic ultrasonography in upper gastrointestinal submucosal tumors: a literature review.  Gastrointest Endosc Clin N Am. 1995;  5 609-614
  • 4 Chak A, Canto M I, Rösch T. et al . Endosonographic differentiation of benign and malignant stromal cell tumors.  Gastrointest Endosc. 1997;  45 468-473
  • 5 Kawamoto K, Yamada Y, Utsunomiya T. et al . Gastrointestinal submucosal tumors: evaluation with endoscopic US.  Radiology. 1997;  205 733-740
  • 6 Zhang Q L, Nian W D. Endoscopic ultrasonography diagnosis in submucosal tumor of stomach.  Endoscopy. 1998;  30 A69-A71
  • 7 Wegener M, Adamek R. Puncture of submucosal and extrinsic tumors: is there a clinical need? Puncture techniques and their accuracy.  Gastrointest Endosc Clin N Am. 1995;  5 615-623
  • 8 Giovannini M, Seitz J F, Monges G. et al . Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.  Endoscopy. 1995;  27 171-177
  • 9 Fritscher-Ravens A, Sriram P V, Schroder S. et al . Stromal tumor as a pitfall in EUS-guided fine-needle aspiration cytology.  Gastrointest Endosc. 2000;  51 746-749
  • 10 Kojima T, Takahashi H, Parra-Blanco A. et al . Diagnosis of submucosal tumor of the upper GI tract by endoscopic resection.  Gastrointest Endosc. 1999;  50 516-522
  • 11 Palazzo L, Landi B, Cellier C. et al . Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours.  Gut. 2000;  46 88-92
  • 12 Ueyama T, Kawamoto K, Iwashita I. et al . Correlation between tumor volume doubling time and histologic findings in gastric smooth muscle tumors: clinical implications of tumor volume doubling time.  J Surg Oncol. 1995;  60 12-17
  • 13 Miyamoto Y, Nakatani M, Ida M. et al . Ultrasonographic findings in gastric cancer: in vitro and in vivo studies.  J Clin Ultrasound. 1989;  17 309-318
  • 14 Li J F, Liu J H, Chen M Y. et al . Ultrasonography of gastric neoplasm.  Chin Med J. 1988;  101 847-852
  • 15 Lim J H, Ko Y T, Lee D H. Transabdominal US staging of gastric cancer.  Abdom Imaging. 1994;  19 527-531
  • 16 Kuntz C, Dux M, Pollock A. et al . Hydrosonography as an alternative or together with endosonography in gastric cancer.  Chirurg. 1998;  69 438-442
  • 17 Miyamoto Y, Tsujimoto F, Tada S. Ultrasonographic diagnosis of submucosal tumors of the stomach: the “bridging layers” sign.  J Clin Ultrasound. 1988;  16 251-258
  • 18 Vakil N, Smith W, Bourgeois K. et al . Endoscopic measurement of lesion size: improved accuracy with image processing.  Gastrointest Endosc. 1994;  40 178-183
  • 19 Margulies C, Krevsky B, Catalano M F. How accurate are endoscopic estimates of size?.  Gastrointest Endosc. 1994;  40 174-177
  • 20 Tsai T, Changchien C, Hu T. et al . Demonstration of gastric submucosal lesions by high-resolution transabdominal sonography.  J Clin Ultrasound. 2000;  28 125-132
  • 21 Futagami K, Hata J, Haruma K. et al . Extracorporeal ultrasound is an effective diagnostic alternative to endoscopic ultrasound for gastric submucosal tumours.  Scand J Gastroenterol. 2001;  36 1222-1226
  • 22 Rutgeerts L, Verbanck J. Sonographic detection of infiltrating gastric lesions.  Acta Gastroenterol Belg. 1984;  47 464-468
  • 23 Derchi L E, Biggi E, Neumaier C E. et al . Ultrasonographic appearances of gastric cancer.  Br J Radiol. 1983;  56 365-370

M. Polkowski, M.D.

Dept. of Gastroenterology, Medical Centre for Postgraduate Education · Institute of Oncology

Roentgena 5 · 02-781 Warsaw · Poland

Fax: + 48-22-644-7601

Email: polek@coi.waw.pl