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Ultraschall Med 2008; 29(3): 236-264
DOI: 10.1055/s-2008-1027388
CME Fortbildung/Continuing Education

© Georg Thieme Verlag KG Stuttgart · New York

Endosonografie subepithelialer Läsionen des Magen-Darmtraktes

Endoscopic Ultrasound of Gastrointestinal Subepithelial LesionsC. Jenssen1 , C. F. Dietrich2
  • 1Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen
  • 2Innere Medizin 2, Caritas-Krankenhaus
Further Information

Publication History

eingereicht: 25.8.2007

angenommen: 24.3.2008

Publication Date:
03 June 2008 (online)

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Key words

review - endoscopic ultrasound - gastrointestinal stromal tumors - classification - education

Kernaussagen

  • Als einziges bildgebendes Verfahren erlaubt die Endosonografie die detaillierte Darstellung der Wandschichten der gastrointestinalen Hohlorgane und ist daher in der Abgrenzung zu extraluminalen Impressionen sowie in der Differenzierung subepithelialer Läsionen allen anderen endoskopischen und bildgebenden Verfahren überlegen.

  • Über 80 % der subepithelialen Tumoren sind endoskopische Zufallsbefunde, die aber dennoch prognostisch relevant sein können. Das gilt insbesondere für die große und heterogene Gruppe der schwach echogenen subepithelialen Tumoren.

  • Auf der Grundlage einer standardisierten endosonografischen Befundbeschreibung sind unter Berücksichtigung der Lokalisation artdiagnostische Differenzialdiagnosen und eine prognostische Einschätzung möglich.

  • Die EUS ist die zentrale apparative Methode im Gesamtkonzept des diagnostischen und therapeutischen Managements subepithelialer Läsionen.

Main statements

  • Endosonography is the only imaging procedure to provide detailed representation of wall layers of the gastrointestinal organs and is therefore superior to all other endoscopic and imaging procedures for the delimitation of extraluminal impressions as well as the differentiation of subepithelial lesions.

  • Over 80 % of subepithelial tumors are endoscopic incidental findings that can be prognostically relevant. This applies in particular to the large and heterogeneous group of hypoechoic subepithelial tumors.

  • Differential diagnoses and prognostic evaluation are possible on the basis of a standardized endosonographic findings description under consideration of the location.

  • EUS is the most important technique for the diagnostic and therapeutic management of subepithelial lesions.

Literatur/References

  • 1 Van Stolk R U. Subepithelial lesions. Van Dam J, Sivak MV Gastrointestinal Endosonography Philadelphia, London, Toronto, Montreal, Sydney, Tokyo; W. B. Saunders 1999: 153-165
    Google Scholar
  • 2 Hwang J H, Kimmey M B. The incidental upper gastrointestinal subepithelial mass.  Gastroenterology. 2004;  126 301-307
    Google Scholar
  • 3 Polkowski M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors.  Endoscopy. 2005;  37 635-645
    Google Scholar
  • 4 Davila R E, Faigel D O. GI stromal tumors.  Gastrointest Endosc. 2003;  58 80-88
    Google Scholar
  • 5 Hwang J H, Saunders M D, Rulyak S J. et al . A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses.  Gastrointest Endosc. 2005;  62 202-208
    Google Scholar
  • 6 Rosch T, Kapfer B, Will U. et al . Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study.  Scand J Gastroenterol. 2002;  37 856-862
    Google Scholar
  • 7 Eckardt A J, Wassef W. Diagnosis of subepithelial tumors in the GI tract. Endoscopy, EUS, and histology: bronze, silver, and gold standard?.  Gastrointest Endosc. 2005;  62 209-212
    Google Scholar
  • 8 Jenssen C, Dietrich C F. Endosonographie bei subepithelialen Tumoren des Verdauungstraktes. Dietrich CF Endosonographie. Lehrbuch und Atlas. Stuttgart. New York. Thieme,; 2008: 187-225
    Google Scholar
  • 9 Will U, Reinholz G, Bosseckert H. Wertigkeit der Endosonographie submuköser Tumore des oberen GIT (abstract).  Ultraschall in Med. 2001;  22 S 118
    Google Scholar
  • 10 Gress F, Schmitt C, Savides T. et al . Interobserver agreement for EUS in the evaluation and diagnosis of submucosal masses.  Gastrointest Endosc. 2001;  53 71-76
    Google Scholar
  • 11 Hizawa K, Kawasaki M, Kouzuki T. et al . Endosonographic classifications of gastrointestinal submucosal tumors.  Digestive Endoscopy. 2000;  12 120-125
    Google Scholar
  • 12 Miettinen M, Sarlomo-Rikala M, Sobin L H. et al . Esophageal stromal tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas.  Am J Surg Pathol. 2000;  24 211-222
    Google Scholar
  • 13 Zhu X, Zhang X Q, Li B M. et al . Esophageal mesenchymal tumors: endoscopy, pathology and immunohistochemistry.  World J Gastroenterol. 2007;  13 768-773
    Google Scholar
  • 14 Nickl N, Gress F, McClave S. et al . Hypoechoic intramural tumor study: final report (abstract).  Gastrointest Endosc. 2002;  55 AB 98
    Google Scholar
  • 15 Miettinen M, Sarlomo-Rikala M, Sobin L H. et al . Gastrointestinal stromal tumors and leiomyosarcomas in the colon: a clinicopathologic, immunohistochemical, and molecular genetic study of 44 cases.  Am J Surg Pathol. 2000;  24 1339-1352
    Google Scholar
  • 16 Miettinen M, Sarlomo-Rikala M, Sobin L H. Mesenchymal tumors of muscularis mucosae of colon and rectum are benign leiomyomas that should be separated from gastrointestinal stromal tumors - a clinicopathologic and immunohistochemical study of eighty-eight cases.  Mod Pathol. 2001;  14 950-956
    Google Scholar
  • 17 Waxman I, Saitoh Y, Raju G S. et al . High-frequency probe EUS-assisted endoscopic mucosal resection: a therapeutic strategy for submucosal tumors of the GI tract.  Gastrointest Endosc. 2002;  55 44-49
    Google Scholar
  • 18 Zhou P H, Yao L Q, Zhong Y S. et al . Role of endoscopic miniprobe ultrasonography in diagnosis of submucosal tumor of large intestine.  World J Gastroenterol. 2004;  10 2444-2446
    Google Scholar
  • 19 Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites.  Semin Diagn Pathol. 2006;  23 70-83
    Google Scholar
  • 20 Frey H, Hetzel G, Greis C. et al .Grundlagen. Dietrich CF Ultraschall Kurs 2006: 1-38
    Google Scholar
  • 21 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
    Google Scholar
  • 22 Saftoiu A, Vilmann P, Hassan H. et al . Utility of colour Doppler endoscopic ultrasound evaluation and guided therapy of submucosal tumours of the upper gastrointestinal tract.  Ultraschall in Med. 2005;  26 487-495
    Google Scholar
  • 23 Chak A, Canto M I, Rosch T. et al . Endosonographic differentiation of benign and malignant stromal cell tumors.  Gastrointest Endosc. 1997;  45 468-473
    Google Scholar
  • 24 Hizawa K, Suekane H, Kawasaki M. et al . Diffuse cystic malformation and neoplasia-associated cystic formation in the stomach. Endosonographic features and diagnosis of tumor depth.  J Clin Gastroenterol. 1997;  25 634-639
    Google Scholar
  • 25 Hizawa K, Matsumoto T, Kouzuki T. et al . Cystic submucosal tumors in the gastrointestinal tract: endosonographic findings and endoscopic removal.  Endoscopy. 2000;  32 712-714
    Google Scholar
  • 26 Matsushita M, Hajiro K, Okazaki K. et al . Gastric aberrant pancreas: EUS analysis in comparison with the histology.  Gastrointest Endosc. 1999;  49 493-497
    Google Scholar
  • 27 Faigel D O, Burke A, Ginsberg G G. et al . The role of endoscopic ultrasound in the evaluation and management of foregut duplications.  Gastrointest Endosc. 1997;  45 99-103
    Google Scholar
  • 28 Eloubeidi M A, Cohn M, Cerfolio R J. et al . Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of foregut duplication cysts: the value of demonstrating detached ciliary tufts in cyst fluid.  Cancer. 2004;  102 253-258
    Google Scholar
  • 29 Matsushita M, Okazaki K. Atypical EUS features of gastric inflammatory fibroid polyps.  Gastrointest Endosc. 2005;  61 637-638
    Google Scholar
  • 30 Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis.  Arch Pathol Lab Med. 2006;  130 1466-1478
    Google Scholar
  • 31 Fletcher C D, Berman J J, Corless C. et al . Diagnosis of gastrointestinal stromal tumors: A consensus approach.  Hum Pathol. 2002;  33 459-465
    Google Scholar
  • 32 Miettinen M, Sobin L H, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up.  Am J Surg Pathol. 2005;  29 52-68
    Google Scholar
  • 33 Akahoshi K, Sumida Y, Matsui N. et al . Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration.  World J Gastroenterol. 2007;  13 2077-2082
    Google Scholar
  • 34 Ando N, Goto H, Niwa Y. et al . The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis.  Gastrointest Endosc. 2002;  55 37-43
    Google Scholar
  • 35 Palazzo L, Landi B, Cellier C. et al . Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours.  Gut. 2000;  46 88-92
    Google Scholar
  • 36 Wiersema M J, Vilmann P, Giovannini M. et al . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 1087-1095
    Google Scholar
  • 37 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
    Google Scholar
  • 38 Polkowsky M, Gerke W, Nasierowska-Guttmeier A. et al . EUS-guided trucut biopsy of hypoechoic intramural tumors of the stomach: a single-center experience in 17 cases (abstract).  Endoscopy. 2006;  39. DOI: 10.1055/s-2006-94771
    Google Scholar
  • 39 Saftoiu A, Vilmann P, Guldhammer S B. et al . Endoscopic ultrasound (EUS)-guided Trucut biopsy adds significant information to EUS-guided fine-needle aspiration in selected patients: A prospective study.  Scand J Gastroenterol. 2007;  42 117-125
    Google Scholar
  • 40 Shim C S, Jung I S. Endoscopic removal of submucosal tumors: preprocedure diagnosis, technical options, and results.  Endoscopy. 2005;  37 646-654
    Google Scholar
  • 41 Lee I L, Lin P Y, Tung S Y. et al . Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer.  Endoscopy. 2006;  38 1024-1028
    Google Scholar
  • 42 Rosch T, Sarbia M, Schumacher B. et al . Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series.  Endoscopy. 2004;  36 788-801
    Google Scholar
  • 43 Nickl N J, Wackerbarth S, Gresse F. et al . Managment of hypoechoic intramural tumors: a decision tree analysis of EUS-directed vs. surgical managment (abstract).  Gastrointest Endosc. 2000;  51 AB 176
    Google Scholar
  • 44 Sato T, Peiper M, Fritscher-Ravens A. et al . Strategy of treatment of submucosal gastric tumors.  Eur J Med Res. 2005;  10 292-295
    Google Scholar
  • 45 Polkowski M, Palucki J, Butruk E. Transabdominal ultrasound for visualizing gastric submucosal tumors diagnosed by endosonography: can surveillance be simplified?.  Endoscopy. 2002;  34 979-983
    Google Scholar
  • 46 Kameyama H, Niwa Y, Arisawa T. et al . Endoscopic ultrasonography in the diagnosis of submucosal lesions of the large intestine.  Gastrointest Endosc. 1997;  46 406-411
    Google Scholar
  • 47 Miettinen M, Furlong M, Sarlomo-Rikala M. et al . Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the rectum and anus: a clinicopathologic, immunohistochemical, and molecular genetic study of 144 cases.  Am J Surg Pathol. 2001;  25 1121-1133
    Google Scholar

Prof. Christoph F. Dietrich

Innere Medizin 2, Caritas-Krankenhaus

Uhlandstr. 7

97980 Bad Mergentheim

Phone: ++ 49/79 31/58 22 01

Fax: ++ 49/79 31/58 22 90

Email: Christoph.Dietrich@ckbm.de