Identify clinical manifestation and endoscopic imaging of upper gastrointestinal tract SMTs Evaluate the effectiveness of endoscopic biopsy by mucosal incision for upper gastrointestinal tract SMTs

1. Kieu Van Tuan, Nguyen Anh Duong, Pham Thi Van Ngoc,
Pham Van Tuyen et al, Bach Mai hospital
CLINICAL, ENDOSCOPIC IMAGING AND THE VALUE OF
ENDOSCOPIC BIOPSY BY MUCOSAL INCISION FOR UPPER
GASTROINTESTINAL SUBMUCOSAL TUMOURS
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2. Diagnostic approaches
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3. Conventional GI Endoscopy
About 1% of the patients underwent
upper GI endoscopy having SMTs
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4. Endoscopic Ultra-sound (EUS)
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5. EUS-guided FNA
Mekky et al (2010), EUS-FNA: 62%
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6. Aim of study
1. To identify clinical manifestation and
endoscopic imaging of upper gastrointestinal
tract SMTs.
2. To evaluate the effectiveness of endoscopic
biopsy by mucosal incision for upper
gastrointestinal tract SMTs.
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7. Object and method
 107 patients with upper GI tract SMTs were
examined in Bach Mai hospital from 11/2014 to
7/2015.
 SMTs > 1 cm were done with endoscopic
biopsy by mucosal incision.
 Prospective study.
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8. Intruments
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9. Endoscopic biopsy technique by mucosal incision
 Incision about 5-10 mm on the surface of SMT with
pre-cut needle knife.
 Tumour sample were collected by biopsy forcep
through the incision.
 Hemoclips will be used to close the incision in case of
necessity.
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10. RESULTS AND DISCUSSION
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11. 11
44.86%
55.14%
Rate (%)
Male
Female
Clinical characteristics
Ihara et al (2013): M/F nearly 1 (13/14)

12. Clinical findings: age, causes of admission
Age 21-83
Causes of admission Number of
patients
Rate %
Health check 64 59,8
Abdominal pain 33 30,8
Dysphagia 3 2,8
Anemia 2 1,9
Blood stool 5 4,7
Total 107 100%
Sato (2005): nausea (63,8%), hemorrage (10,6%) and abdominal pain 8,5%.
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13. Endoscopic findings
Tumor sites
Tumor located Number of
patients
Rate %
Esophagus 29 27,1
Stomach 62 57,9
Duodenum bulb 7 6,6
Duodenum 9 8,4
Total 107 100
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14. Endoscopic findings
Tumor size
Size
Site
<10 mm 10-20 mm >20 mm Tổng
Esophagus 15 (51,7%) 11 (38%) 3 (10,3%) 29 (100%)
Stomach 29 (46,8%) 20 (32,2%) 13 (21%) 62 (100%)
Duodenum 8 (50%) 7 (43,75%) 1 (6,25%) 16 (100%)
Total 52 (48,6%) 38 (35,5%) 17 (15,9%) 107 (100%)
Average tumor size on esophagus is 14 mm (10-25mm), stomach is 23
mm (10-40 mm). JungHo Kim (2013): 21,8 mm
im (2013): 21,8 mm
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15. Endoscopic findings
Gastric SMTs
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16. EUS, Endoscopic findings
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17. EUS, Endoscopic findings
Esophageal SMTs
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18. Endoscopic findings
Duodenal SMTs
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19. Successful rate of biopsy
Our research: 81,4%.
Mekky et al (2010), EUS-FNA: 62%
Ihara, Matsuzaka et al: 85,2%. Jung Ho Kim (HQ): 90,9%
0
20
40
60
80
100
120
Esophagus Stomach
Successful
Not Successful
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20. Histopathology
Esophagus
Pathology N Rate %
Leiomyoma 11 78,57
Granuloma 1 7,14
Lymphangiomas 2 14,29
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21. Cas 1: Vu Van L, M 29 yrs, esophageal leiomyoma
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22. Histopathology
Stomach
Tumors N Rate (%)
Leiomyoma 8 29,6
Lipoma 3 11,1
GIST 10 37,0
Carcinoid 1 3,7
Pancreatic rest 3 11,1
Schwanoma 2 7,4
Jung Ho Kim: U GIST (18,2%). Ihara, Matsuzaka và CS: 59,26%
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23. Cas 2: Nguyen thi X, F, 50 yrs
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24. Cas 2:
Nguyen thi X, F, 50 yrs, GIST, CD34(+), CD117(+)
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25. Cas 3: Hoang thi L, 53yrs, Lipoma
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26. Complication
 Neither delay hemorrage nor perforation after
procedure.
 Intra-procedural bleeding:
• Esophagus: 1/14 (7,1%)
• Stomach: 4/33 (12,1%)
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27. CONCLUSION
 9,4% of patients have clinical symptoms caused by SMTs
 SMTs of upper GI tract are mainly found on stomach
(57,9%).
 Average sizes of tumors on esophagus and stomach are
14 mm and 23 mm respectively.
 Pathology:
• Esophagus: leiomyoma (78,57%)
• Stomach: GIST (37,0%) and leiomyoma (29,6%)
 Successful rate of the biopsy method: 87,2%
 No serious complication were found in this study
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28. Xin c¶m ¬n!Thank you!
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