AIM: To explore whether clinical presentations of gastric small gastrointestinal tumors(GISTs) mimics gastrointestinal dyspepsia symptoms.METHODS: The endosonographic data of 167 patients who underwent endoscopic subm...AIM: To explore whether clinical presentations of gastric small gastrointestinal tumors(GISTs) mimics gastrointestinal dyspepsia symptoms.METHODS: The endosonographic data of 167 patients who underwent endoscopic submucosal dissection at the Tianjin Medical University General Hospital, China between 2009 and 2011 were analyzed. GISTs and leiomyomas had a similar intragastric distribution and similar locations within the gastric wall. Therefore, patients with GISTs were chosen as the study group and those with leiomyomas were chosen as the control group. Dyspepsia symptom questionnaires were used to investigate and compare the gastrointestinal symptoms of patients with GISTs and those with gastric leiomyomas before and after endoscopic submucosal dissection(ESD). The questionnaires evaluated symptoms such as epigastric pain, heartburn, regurgitation, epigastric discomfort, nausea and vomiting, abdominal bloating, and eructation. Symptoms were assessed using a four-point scoring scale.RESULTS: GISTs were the most common gastric submucosal lesion(67 cases, 40.12%), followed by leiomyomas(38 cases, 22.75%). Both groups were similar in terms of gender distribution(P = 0.49), intragastric location(P = 0.525), and originating layer within the gastric wall(P = 0.449), but leiomyomas were more commonly found in the proximal fundus(P < 0.05). Overall, 94.2% of the patients with small GISTs and 93.5% of those with gastric leiomyomas experienced some dyspepsia; however, total symptom scores were significantly lower in the GIST group than in the leiomyoma group(1.34 ± 1.27 vs 2.20 ± 1.70, P < 0.05). Each component of the symptom score demonstrated a statistically significant improvement in the GIST patients after ESD(P < 0.05), including epigastric pain(0.80 ± 0.90 vs 0.13 ± 0.46), heartburn(0.63 ± 1.08 vs 0.13 ± 0.41), regurgitation(0.55 ± 0.87 vs 0.22 ± 0.57), epigastric discomfort(0.70 ± 0.98 vs 0.32 ± 0.47), nausea and vomiting(0.27 ± 0.62 vs 0.05 ± 0.21), abdominal bloating(0.70 ± 0.90 vs 0.27 ± 0.49), and eructation(0.36 ± 0.61 vs 0.21 ± 0.46). For leiomyoma patients, symptoms such as heartburn, nausea, vomiting, and eructation improved after treatment; however, these improvements were not statistically significant(P > 0.05). Thus, the pathophysiology of dyspepsia symptoms may be different between the two groups. CONCLUSION: Symptoms of gastric small GISTs may mimic those of functional dyspepsia. An alternative diagnosis should be considered in patients with functional dyspepsia and treatment failure.展开更多
Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract,but gastric stromal tumors(GSTs)are the most common.All GSTs have the potential to become malignant,and these can be divided into fou...Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract,but gastric stromal tumors(GSTs)are the most common.All GSTs have the potential to become malignant,and these can be divided into four different grades by risk from low to high:Very low risk,low risk,medium risk,and high risk.Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter.However,it is not clear whether small GSTs(sGSTs,i.e.,those smaller than 2 cm in diameter)should be treated as early as possible.The National Comprehensive Cancer Network recommends that endoscopic ultrasonographyguided(EUS-guided)fine-needle aspiration biopsy and imaging(computed tomography or magnetic-resonance imaging)be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment.When EUS indicates a higher risk of tumor,surgical resection is recommended.There are some questions on whether sGSTs also require early treatment.Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective.We here address whether endoscopic therapy is also suitable for sGSTs.In this paper,we try to explain three questions:(1)Does sGST require treatment?(2)Is digestive endoscopy a safe and effective means of treating sGST?and(3)When sGSTs are at different sites and depths,which endoscopic treatment method is more suitable?展开更多
目的:探讨多层螺旋CT对胃间质瘤和小肠间质瘤的CT征象和病理特点。方法:选取中山大学附属第三医院2015年1月—2021年2月收治的70例胃间质瘤和小肠间质瘤患者的临床资料,并进行回顾性分析,观察其多层螺旋CT征象,分析多层螺旋CT征象与病...目的:探讨多层螺旋CT对胃间质瘤和小肠间质瘤的CT征象和病理特点。方法:选取中山大学附属第三医院2015年1月—2021年2月收治的70例胃间质瘤和小肠间质瘤患者的临床资料,并进行回顾性分析,观察其多层螺旋CT征象,分析多层螺旋CT征象与病理分级的关系,并计算多层螺旋CT鉴别胃肠道间质瘤良恶性符合率。结果:肿瘤最长径<50 m m、形状规则、边界清晰、腔外生长以及无转移是胃间质瘤和小肠间质瘤患者典型多层螺旋CT征象;最长径≥50 mm、形状不规则、边界不清晰、密度不均匀、不均匀强化、转移等CT征象与病理分级呈正相关(P<0.05);多层螺旋CT鉴别胃肠道间质瘤良恶性符合率分别为57.50%、70.00%。结论:多层螺旋CT对胃间质瘤和小肠间质瘤的CT征象有明显特异性,具有良好诊断价值,可用于判断病理分级、鉴别良恶性,对临床有很好诊断意义。展开更多
基金Supported by National Natural Science Foundation of China,No.81070283
文摘AIM: To explore whether clinical presentations of gastric small gastrointestinal tumors(GISTs) mimics gastrointestinal dyspepsia symptoms.METHODS: The endosonographic data of 167 patients who underwent endoscopic submucosal dissection at the Tianjin Medical University General Hospital, China between 2009 and 2011 were analyzed. GISTs and leiomyomas had a similar intragastric distribution and similar locations within the gastric wall. Therefore, patients with GISTs were chosen as the study group and those with leiomyomas were chosen as the control group. Dyspepsia symptom questionnaires were used to investigate and compare the gastrointestinal symptoms of patients with GISTs and those with gastric leiomyomas before and after endoscopic submucosal dissection(ESD). The questionnaires evaluated symptoms such as epigastric pain, heartburn, regurgitation, epigastric discomfort, nausea and vomiting, abdominal bloating, and eructation. Symptoms were assessed using a four-point scoring scale.RESULTS: GISTs were the most common gastric submucosal lesion(67 cases, 40.12%), followed by leiomyomas(38 cases, 22.75%). Both groups were similar in terms of gender distribution(P = 0.49), intragastric location(P = 0.525), and originating layer within the gastric wall(P = 0.449), but leiomyomas were more commonly found in the proximal fundus(P < 0.05). Overall, 94.2% of the patients with small GISTs and 93.5% of those with gastric leiomyomas experienced some dyspepsia; however, total symptom scores were significantly lower in the GIST group than in the leiomyoma group(1.34 ± 1.27 vs 2.20 ± 1.70, P < 0.05). Each component of the symptom score demonstrated a statistically significant improvement in the GIST patients after ESD(P < 0.05), including epigastric pain(0.80 ± 0.90 vs 0.13 ± 0.46), heartburn(0.63 ± 1.08 vs 0.13 ± 0.41), regurgitation(0.55 ± 0.87 vs 0.22 ± 0.57), epigastric discomfort(0.70 ± 0.98 vs 0.32 ± 0.47), nausea and vomiting(0.27 ± 0.62 vs 0.05 ± 0.21), abdominal bloating(0.70 ± 0.90 vs 0.27 ± 0.49), and eructation(0.36 ± 0.61 vs 0.21 ± 0.46). For leiomyoma patients, symptoms such as heartburn, nausea, vomiting, and eructation improved after treatment; however, these improvements were not statistically significant(P > 0.05). Thus, the pathophysiology of dyspepsia symptoms may be different between the two groups. CONCLUSION: Symptoms of gastric small GISTs may mimic those of functional dyspepsia. An alternative diagnosis should be considered in patients with functional dyspepsia and treatment failure.
基金Supported by the Natural Science Foundation of Guangdong Province of China,No.2018A0303130278.
文摘Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract,but gastric stromal tumors(GSTs)are the most common.All GSTs have the potential to become malignant,and these can be divided into four different grades by risk from low to high:Very low risk,low risk,medium risk,and high risk.Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter.However,it is not clear whether small GSTs(sGSTs,i.e.,those smaller than 2 cm in diameter)should be treated as early as possible.The National Comprehensive Cancer Network recommends that endoscopic ultrasonographyguided(EUS-guided)fine-needle aspiration biopsy and imaging(computed tomography or magnetic-resonance imaging)be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment.When EUS indicates a higher risk of tumor,surgical resection is recommended.There are some questions on whether sGSTs also require early treatment.Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective.We here address whether endoscopic therapy is also suitable for sGSTs.In this paper,we try to explain three questions:(1)Does sGST require treatment?(2)Is digestive endoscopy a safe and effective means of treating sGST?and(3)When sGSTs are at different sites and depths,which endoscopic treatment method is more suitable?
文摘目的:探讨多层螺旋CT对胃间质瘤和小肠间质瘤的CT征象和病理特点。方法:选取中山大学附属第三医院2015年1月—2021年2月收治的70例胃间质瘤和小肠间质瘤患者的临床资料,并进行回顾性分析,观察其多层螺旋CT征象,分析多层螺旋CT征象与病理分级的关系,并计算多层螺旋CT鉴别胃肠道间质瘤良恶性符合率。结果:肿瘤最长径<50 m m、形状规则、边界清晰、腔外生长以及无转移是胃间质瘤和小肠间质瘤患者典型多层螺旋CT征象;最长径≥50 mm、形状不规则、边界不清晰、密度不均匀、不均匀强化、转移等CT征象与病理分级呈正相关(P<0.05);多层螺旋CT鉴别胃肠道间质瘤良恶性符合率分别为57.50%、70.00%。结论:多层螺旋CT对胃间质瘤和小肠间质瘤的CT征象有明显特异性,具有良好诊断价值,可用于判断病理分级、鉴别良恶性,对临床有很好诊断意义。
