Submucosal lesions / extrinsic compression of the upper digestive tract: Is it worthwhile to do endoscopic ultrasonography? Is it so in all cases?

Introduction: finding of localised protrusions in digestive tract wall, submucosal lesions (SL) or extrinsic compression (EC), during ultrasound is not unusual and is one indications for carrying out endoscopic ultrasonography (EUS). However, as this exam is not available in the majority of centres and is not without additional costs and risks, the ration of costs to benefits must be examined.

Aim: determine value of EUS in assessing SL / EC of the upper digestive tract. Material: 352 patients with suspected SL / EC were studied. Echoendoscope (290) and / or miniprobe (12MHz: 61; 20MHz: 2) was used.

Results: The exam was normal in 28. Lesions originating in the mucosal layer: 41; SL (parietal): 240. Non-pathological EC (31): spleen-2; gallbladder-4; liver-3; pancreas-1, splenic vessels-10; aorta-2; azygos arch-3; intestinal ansa-6. Pathological EC (10): simple hepatic cyst-2; gallstone-2; inflammatory adenopathy-1; retroperitoneal cystic lesion-2; splenomegaly-1; hydatid liver cyst-1; lung tumour-1. SL (240): 141 gastric, 83 oesophageal, 16 duodenal. Layer(s) of the digestive tract wall involved: layer 2–39; layer 3–67; layer 4–107; layers 1, 2, 3–14; layers 2, 3, 4–1; layers 3, 4–7; layers 2, 3–2; layers 1, 2, 3, 4–3. Definitive diagnosis made in 200: Stromal t., benign-105; malignant-23; Lipoma-34; Ectopic pancreas-22; Carcinoid t.-1; Cystic enlargement of submucosal glands-4; Oesophageal duplication cyst-8; Gastric duplication cyst-3, Granular cell t.- 2; Duodenal mucocele-1; Varices-2. Surgical resection indicated in 27, endoscopic in 13 and EUS-guided needle aspiration in 22.

Conclusions: EUS should always be done when SL / EC is suspected. Is highly useful in differential diagnosis of many lesions, making possible classify patients into treatment groups: no further action, watchful waiting, endoscopic resection or surgery.