ENDOSONOGRAPHIC CHARACTERIZATION OF DUODENAL ELEVATED LESIONS

Background: Endoscopic diagnosis of duodenal elevated lesions is probl ematic for two reasons. Endoscopic biopsy often fails to confirm a his tologic diagnosis of submucosal lesions. Moreover, a biopsy specimen i s often insufficient to verify a differential diagnosis of mucosal les ions. In this study, we evaluated the usefulness of endosonography in the resolution of these problems. Methods: The endoscopic and endosono graphic features of 15 duodenal elevated lesions that had been confirm ed histologically in our hospital were reviewed retrospectively. Resul ts: Of the 15 cases, 8 were submucosal lesions (lipoma, Brunner's glan d hyperplasia, lymphangioma, carcinoid tumors, leiomyoma, and malignan t lymphoma); the rest were mucosal lesions. A correct histologic diagn osis based on endoscopic biopsies was obtained in only 6 cases (three submucosal lesions and three mucosal lesions). On the other hand, ultr asonography was useful in the characterization of all submucosal lesio ns based on their echo lever, layer of origin, and tissue homogeneity. As for mucosal lesions, the depth of infiltration was correctly estim ated with endosonography. Either endoscopic resection or surgery was s elected an the basis of endosonographic information. Conclusions: We c onclude that endosonography is useful in the differential diagnosis of submucosal lesions and in determining suitable treatment methods for duodenal mucosal and submucosal lesions.