Values of endoscopic ultrasonography for diagnosis and treatment of duodenal cysts

Objective: Duodenal cysts is one of submucosal protruding lesions, it is a cystic change in intraintestinal wall. In the past, it was thought as a rare disease, not introduced and described in textbooks in detail. But recently, the disease is more and more found and acknowledged with the development of endoscopic equipment and technique. It is an important issue for clinicans to diagnose correctly and treat reasonably this disease. endoscopic ultrasonograhy (EUS)has the functions both endoscopy and ultrasonography, which can show the structure of the intestinal wall and the relationship with the adjacent organs. The clinical application of EUS has greatly improved the our diagnosis, treatment and understanding levels of this kind of diseases.

In the present study, we are going to investigate clinical values of EUS with miniature ultrasonic probes for diagnosis and treatment of duodenal cysts.

Methods: A total of 105 outpatients diagnosed with duodenal cysts by EUS in our department during January 2003 to August 2009 were investigated. Instruments of EUS include Olympus GIF-2T-240 duoble-cavity electronic gastroscope, Olympus MAJ drive systems of high-frequency echoprobe, UM-DP12–25R miniature ultrasonic probes with frequency spectrum of 12–15MHz and Daker WP-800 water pump. According to the location and size of the lesions from conventional gastrooscope, we choose the 12MHz frequency ultrasonic microprobe, and using water-soaking or water-pour-in methods to examine the lesions. Some patients underwent endoscopic biopsy. Clinical manifestation and results of conventional gastroscope, EUS as well as following-up of patients with duodenal cysts were analyzed and summarized.

Results: A total of 105 patients with duodenal cysts did not presented any symptoms related their lesions; The percentage of the lesions located in the bulb of duodenum, junction of bulb and descending part, descending part is respectively 64.8% (68/105), 17.1% (18/105), 18.1% (19/105); EUS showed the ultrasonic features of the lesion were intramural, anechoic, clear margin, originated from submucosal and enhanced echo in the behind of lesion and would deformed by compression with probe, and the layer and construction of surrounding intestinal are normal; The lesions of 95 patients are single, 10 cases are multiple among which 6 cases are two lesions, 4 cases are three lesions. The lesions are always oval, nmean diameter is 0.78cm, ranged 0.27cm-1.73cm. EUS can clearly show origin, size and nature of duodenal cysts, their characteristic and diagnostic ultrasonic images were easy to differentiate with that of other submucosal lesions. 10 patients with lesions were deeply biopsied by large biopsy forceps, we can see yellow fluid flowed out, meantime the protruding lesions collapsed. The histopathological result were the columnar gland cell below the mucosal muscular layer papilla hyperplasia, the glandular tubes dilated to cystic formation with the secretion and retention of mucus, and glandular cells were not heterotype. 6 of 105 patients were performed fine-needle aspiration primarily to exclude angioma and exhausted cystic liquid to achieve better therapeutic effects. And the cystic liquid is yellow, bright and transparent, it contained some leucocytes, not protein, enzyme and other ingredient. The result of follow-up to 82 patients with gastroscope or EUS showed that duodenal cysts were unchanged within 5 years.

C onclusions: The present study illustrated that EUS is superior to conventional endoscopy, which wound be the optimum examination, obviously in diagnosis and treatment for duodenal cysts. We can accurately diagnose from the endoscopic and ultrasonic images. Following up the patients in following 3–4 years, there are not any related symptom, the size of lesions did not change significantly, which proved this disease is benign. Thus, we considered that the patient who have related symptom or complication of duodenal cysts, or the size of whose cysts is larger than 2cm, should be considered to be treated in endoscopy, the principle of treatment to choose the methods is simple, minimally invasive and safe. Because the adverse consequence resulted from treatment would be more than the disease itself. For the lesion smaller than 2cm, follow-up and observation are always best choose. These patients could be rechecked 2–3 years once. We must avoid excessive and harmful examination and treatment.

Keywords: endoscopic ultrasonography; Duodenal cyst; Diagnosis; Treatment