The value of endoscopic ultrasonography in the diagnosis and treatment of duodenum protuberances lesions

Objective: To explore the clincic and endoscopic ultrasonography (EUS) features of duodenum protuberances lesions and to evaluate the value of EUS in the diagnosis and treatment of duodenum protuberances lesions. Methods: 106 cases of duodenum protuberances lesions found by endoscopy from May 2003 to May 2009, 48 cases which could not diagnosised by gastroscopy were examined by EUS or endoscopic ultrasonography miniature probe (UMP) with high frequency. To confirmed diagnosis and chosed treating methods according to their internal echo pattern, size, layer of origin and boundary. Results: Through EUS, of which 10 cases were diagnosed with gastrointestinal stromal tumors, 12 with Brunner's gland adenoma, 2 with lipomas, 6 with polyps, 2 with cyst, 1 with ectopic pancreas, 2 with duodenum cancer, 1 with primary malignant lymphoma of duodenum, 3 with extrinsic compression, 7 with minor papilla, 2 with normal cases. After EUS examinations, 16 lesions that located in mucosa (m) or mucosa muscularis (mm) or submucosa (sm) were performed endoscopic resection, their pathology showed: 6 inflammatory polyps, 4 stromal tumors, 2 adenomatous polyps, 3 Brunner's gland adenoma, 1 ectopic pancreas, 1 lipoma. 2 of 6 lesions located in muscularis propria (mp were resected surgical operation, their pathology showed stromal tumors. 4 were followed up by EUS. The histological results of 18 patients were consistent with the preoperative diagnosis of EUS, with 85.7% (18/21) diagnostic accuracy. Conclusion: EUS can clearly show five layers of duodenums and histologic structure of adjacent organs, EUS is quite a valuable means for the definite diagnosis of duodenum protuberances lesions, and helpful in choosing the effective treating methods.

Keywords: duodenum protuberances lesions; endoscopic ultrasonography; diagnosis; treatment