Endosonografie subepithelialer Läsionen des Magen-Darmtraktes

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
• 2 Hwang J H, Kimmey M B. The incidental upper gastrointestinal subepithelial mass.  Gastroenterology. 2004;  126 301-307
• 3 Polkowski M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors.  Endoscopy. 2005;  37 635-645
• 4 Davila R E, Faigel D O. GI stromal tumors.  Gastrointest Endosc. 2003;  58 80-88
• 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
• 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
• 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
• 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
• 9 Will U, Reinholz G, Bosseckert H. Wertigkeit der Endosonographie submuköser Tumore des oberen GIT (abstract).  Ultraschall in Med. 2001;  22 S 118
• 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
• 11 Hizawa K, Kawasaki M, Kouzuki T. et al . Endosonographic classifications of gastrointestinal submucosal tumors.  Digestive Endoscopy. 2000;  12 120-125
• 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
• 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
• 14 Nickl N, Gress F, McClave S. et al . Hypoechoic intramural tumor study: final report (abstract).  Gastrointest Endosc. 2002;  55 AB 98
• 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
• 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
• 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
• 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
• 19 Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites.  Semin Diagn Pathol. 2006;  23 70-83
• 20 Frey H, Hetzel G, Greis C. et al .Grundlagen. Dietrich CF Ultraschall Kurs 2006: 1-38
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 29 Matsushita M, Okazaki K. Atypical EUS features of gastric inflammatory fibroid polyps.  Gastrointest Endosc. 2005;  61 637-638
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 40 Shim C S, Jung I S. Endoscopic removal of submucosal tumors: preprocedure diagnosis, technical options, and results.  Endoscopy. 2005;  37 646-654
• 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
• 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
• 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
• 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
• 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
• 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
• 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