Utilidad de la ultrasonografía endoscópica (USE) en la evaluación de los tumores submucosos y compresiones extrínsecas del tubo digestivo

[Cystic dystrophy of the duodenal wall. An underdiagnosed complication in aberrant pancreas]

Cystic dystrophy of the duodenal wall is an uncommon complication of aberrant pancreas characterized by increased duodenal wall thickness associated with intraparietal cystic lesions. We present the case of a male patient with cystic dystrophy of the duodenal wall, which posed major diagnostic problems due to the difficulty of distinguishing this entity from tumors of the head of the pancreas. Echoendoscopy was useful in establishing the definitive diagnosis, allowing puncture-evacuation of the intracystic contents with resolution of obstructive symptoms.

Endoscopic sonographically guided fine-needle aspiration yield in submucosal tumors of the gastrointestinal tract

OBJECTIVE

To study the yield of endoscopic ultrasonographically guided fine-needle aspiration cytologic examination in the diagnosis of submucosal masses.

METHODS

From 1999 to 2003, 10 patients underwent ultrasonographically guided fine-needle aspiration for the cytologic diagnosis of submucosal masses in our institution. The endoscopic ultrasonography records and the cytology database were consulted, and the reports were analyzed, as were slide material and the technical aspects related to these procedures. All procedures were performed under conscious sedation and cardiorespiratory monitoring on an outpatient basis. Ten patients (4 men and 6 women; mean age, 60.8 years) were studied.

RESULTS

Eight lesions were located in the stomach, and 2 were located in the esophagus, with a mean diameter of 3.3 cm. An experienced cytopathologist was present on-site during all procedures for assessment of adequacy and preliminary cytologic examination. Cytologic diagnoses were obtained in 8 cases as follows: 6 gastrointestinal stromal tumors, 1 organizing submucosal hematoma, and 1 low-grade mucosa-associated lymphoid tissue-associated lymphoma. Two cases consisted of scant gastric epithelium only and were considered nondiagnostic. The cytologic diagnoses guided further clinical treatment.

CONCLUSIONS

Ultrasonographically guided fine-needle aspiration with cytopathologic analysis has a high accuracy rate (80%) for diagnosing submucosal lesions. These findings potentially affect clinical decision making.