Endosonographic surveillance of small gastrointestinal tumors originating from muscularis propria.
BACKGROUND
Submucosal tumors (SMT) are not uncommonly found during upper endoscopy. Management for small SMT originating from muscularis propria (MP) is controversial. Data regarding regular endoscopic ultrasound (EUS) surveillance is scarce. We report our experience in using EUS to monitor these tumors.


METHODS
Patients with SMT originated from MP as confirmed by EUS were recruited. The maximal diameter, echo pattern, presence of cystic spaces and regularity of extra-luminal margin were documented. Patients with large tumors (maximal diameter > 3 cm), heterogeneous echo pattern, presence of cystic spaces or irregular extra-luminal margin were offered surgery in view of malignant risk. Patients with small tumor and benign EUS features were offered regular EUS surveillance or surgery if they wished. The progress of those patients who underwent EUS surveillance were studied.


RESULTS
From January 2002 to December 2007, there were 93 patients with SMT originating from MP. Forty-nine patients had a small tumor and benign EUS features. Only two of these patients chose surgery. The histopathological results were low risk gastrointestinal stromal tumor (GIST) in both patients. Twenty-three patients elected to undergo regular EUS surveillance for a mean period of 17.3 months (range 6-42 months). Three patients (13.0%) showed interval increase in tumor size. There was no change in other EUS features. Surgery was performed in these 3 patients. Histological examination revealed schwannoma in 2 patients and low risk GIST in 1 patient.


CONCLUSIONS
It remains unclear whether EUS surveillance for small tumors originating from MP in the upper gastrointestinal tract is useful.
Lok
Ka-Ho
KH
Department of Surgery, Tuen Mun Hospital, New Territories, Hong Kong. lokkaho@netvigator.com
Lai
Lawrence
L
Yiu
Hak-Lim
HL
Szeto
Ming-Leung
ML
Leung
Siu-Kee
SK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005753:Gastric Mucosa / Q000000981:diagnostic imaging; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D013997:Time Factors; D055815:Young Adult