The clinical value of endoscopic ultrasonography combined with endoscopic treatment for upper gastrointestinal lifting lesions

ObjectiveThe present investigation is designed to assess the synergistic impact of endoscopic ultrasonography (EUS)paired with endoscopic therapy in addressing upper gastrointestinal (GI) lesions that protrude.MethodsOur approach involved retrospectively reviewing medical records to analyze 106 instances of upper GI protruding lesions identified via EUS at our institution, all of which were treated with either endoscopic techniques or surgery. Sample size was determined based on a prior pilot study, where the diagnostic concordance rate of EUS for upper GI protruding lesions was approximately75%. Using a margin of error of 5% and a confidence level of 95%, the calculated minimum sample size was83cases;106 patients were ultimately included to account for potential loss to follow-up. Comprehensive clinical and pathological information was systematically documented for each patient.ResultsAmong the106cases, endoscopic treatment was successful in101cases,2 cases were transferred to surgical treatment midway, and 3 cases were directly treated with surgery. The most common pathological types included polyps in 26 cases (24.53%), inflammatory changes in 25 cases (23.58%), leiomyomas in 22 cases (20.75%), gastrointestinal stromal tumors (GIST)in 11 cases (10.38%), and cysts in 10 cases (9.43%). The diagnostic concordance rate between EUS and pathological diagnosis was 81.13% (86/106; 95% confidence interval [CI]: 73.25–87.46%). For common lesion subtypes, the concordance rates were as follows: polyps (89.66%,26/29;95%CI:73.78–97.23%), leiomyomas (86.36%, 22/25; 95% CI: 68.17–95.84%), and GIST (73.33%, 11/15; 95% CI: 45.30–91.15%). Additionally, EUS showed favorable diagnostic performance for these lesions: sensitivity and specificity were 92.86%/98.04% for polyps,88.00%/97.06% for leiomyomas, and 73.33%/98.99% for GIST, respectively. Polyps are more common in the stomach and mostly originate from the mucosal layer; leiomyomas are more common in the esophagus and originate from the muscularis mucosae and the muscularis propria; GIST are more common in the stomach and mostly originate from the muscularis propria.ConclusionThe study’s conclusions highlight the remarkable precision of EUS in determining the intricacies of upper GI protrusions. Moreover, endoscopic treatments predicated on EUS assessments were found to be clinically safe, with a low incidence of postoperative adverse effects. Nonetheless, for rarer GI pathologies, such as schwannomas and granular cell tumors, there is an evident need for enhanced clinical acumen to mitigate the risk of misdiagnosis. The limitations of this single-center, retrospective study (e.g., small sample size, lack of long-term follow-up) should be considered when interpreting these findings.