中国消化道黏膜下肿瘤内镜诊治专家共识（2018版）

Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumor （Version 2018）

“消化道黏膜下肿瘤内镜诊治专家共识”是由中华医学会消化内镜学分会外科学组、中国医师协会内镜医师分会消化内镜专业委员会、中华医学会外科学分会胃肠外科学组制定的第一个有关于消化道黏膜下肿瘤（SMT）的内镜诊治中国专家共识。SMT是指起源于消化道黏膜层以下各层（主要包括黏膜肌层、黏膜下层、固有肌层）的隆起性病变。内镜治疗SMT是改善患者生活质量、减轻家庭和社会负担、节约国家医疗资源的有效途径。为此，本共识依据我国SMT诊疗现状．结合国内外的文献及专家经验，提出了内镜下切除的适应证，包括：（1）对于术前检查怀疑或活检病理证实存在恶性潜能的肿瘤，在内镜切除技术允许的前提下，考虑内镜切除；（2）对于有症状（如出血、梗阻）的SMT，考虑内镜切除；（3）对于术前检查怀疑或病理证实良性、但不能规律随访或随访期内瘤体短时间增大及内镜治疗意愿强烈的患者．可选择行内镜下切除。SMT经内镜切除并经病理学的最终诊断后，根据不同病理类型，选择不同处理方式．推荐如下：（1）病理提示为良性病变，如脂肪瘤或平滑肌瘤，术后常规处理及随访；（2）无恶性潜能SMT，如直径〈1cm且分化良好者的直肠神经内分泌肿瘤（NET），一般病程良好，完整切除后5年生存率为98．9％-100％，且复发率极低，术后病理检查确定切缘阴性后，常规随访；（3）低恶性潜能SMT，如低风险胃肠问质瘤（GIST），需在治疗后每6～12个月进行内镜超声（EUS）或影像学评估，再按照临床指示进行处理；（4）中-高恶性潜能SMT，如术后病理证实为3、4型胃NET，直径〉2cm的结直肠NET及中-高风险GIST，需追加治疗。治疗方案的选择参见各疾病相关指南。本共识为国内各级医院提供了一个适合我国国情的内镜SMT诊疗规范。

The Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumors is the first guideline in the area of gastrointestinal submucosal tumors （SMT） in China. SMTs of the Gastrointestinal tract are bulge lesions that originate from muscularis mucosa, submucosa, or muscularis propria. Endoscopic treatment of SMT is an effective way to improve the quality of life for patients, to reduce the burden on patients＇ families and the society, and to save national medical resources. For these reasons, this consensus has proposed the indications for endoscopic resection, on the basis of current status of diagnosis and treatment for SMT in China, and in combination with domestic and foreign literature and experts＇ experience： （ 1 ）For tumors with malignant potential suspected by preoperative examination or pathologically confirmed through biopsy, endoscopic resection should be considered when technically possible; （2） Endoscopic resection is indicated for SMT with symptoms （e.g. hemorrhage and obstruction） ; （3） For benign tumors suspected by preoperative examinations or confirmed by pathological examination, endoscopic resection could be considered when patients cannot attend regular follow-up, tumors grow rapidly in a short period or patients have a strong willing for endoscopic treatment. After endoscopic resection for SMT, different treatment algorithms should be recommended according to pathological types ： （ 1 ） For benign lesions, such as lipoma and leiomyoma, postoperative routine treatment and follow-up are recommended ; （2） For SMT without malignant potential, such as well-differentiated rectal neruoendocrine tumors （NET） that are 〈 1 cm, survival rate after complete resection is approximately 98.9%-100% and the recurrence rate is extremely low. Therefore, routine follow-up is recommended when the margin were confirmed negative pathologically; （3）Low-malignant-poteential SMT, such as low-risk GIST, should be assessed by endoscopic ultrasonography or imaging every 6-12 months, and then managed according to clinical instructions; （4）Medium/high-malignant-potential SMT, such as type 3 and type d gastric NET, colorectal NET that are 〉2 cm, and medium/high-risk GISTs, additional treatment is required according to the guidelines for each specific disease. This expert consensus aims to provide an endoscopic SMT diagnosis and treatment standard,which fits our current national status, to domestic hospitals at all levels.