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Diagnostic et surveillance de leiomyomes œsophagiens et gastriques par ultrasonographie endoscopique (USE)

Diagnosis and follow-up investigation of esophageal and stomach leiomyomas by endoscopic ultrasonography (EUS)

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Acta Endoscopica

Résumé

De 1991 à 1994 nous avons investigué par endoscopie et ultrasonographie endoscopique (USE) 39 patients (19 hommes et 20 femmes — limite d’âge: 39–85 ans).

Les examens de surveillance ont été réalisés après un intervalle de 6 à 24 mois chez 10 patients. La majorité des malades était asymptomatique.

La dysphagie a été observée chez seulement 8 patients, la douleur rétrosternale chez deux malades et une hémorragie gastro-intestinale dans 8 cas.

L’échoendoscopie a révélé des images comportant une structure hypoéchogène, homogène, à bords réguliers prenant son origine au niveau de la tunique musculaire. Les dimensions des leiomyomes variaient de 0,9 × 0,4 à 7,7 × 6,0 cm. Les examens de surveillance ont révélé un accroissement des dimensions du leiomyome dans un seul cas, après un intervalle de 12 mois. Nous n’avons constaté aucune corrélation entre les symptômes cliniques et les dimensions du leiomyome. Une intervention chirurgicale a été pratiquée dans 6 cas. Chez 5 malades, le diagnostic endoscopique et échoendoscopique du leiomyome a été confirmé à la fois par la chirurgie et l’examen histopathologique. Néanmoins, dans un cas opéré, le diagnostic de leiomyome n’a pas été confirmé et l’examen histologique a révélé un kyste bronchogénique.

En conclusion, le leiomyome de l’œsophage et de l’estomac peuvent être détectés de façon efficace par échoendoscopie et ces lésions expriment une faible tendance à la croissance. Pour cette raison il nous semble suffisant de contrôler les leiomyomes non compliqués après un intervalle de temps de 24 mois.

Summary

From 1991 to 1994 we investigated 39 patients (19 men, 39–85 years old) with leiomyomas of the esophagus and stomach by endoscopy and by endoscopic ultrasonography (EUS). Follow-up investigations after 6 to 24 months were performed in 10 patients. The majority of patients was without specific symptoms. Dysphagia occurred in only 8 patients, retrosternal pain in 2 patients, and gastrointestinal bleeding in 8 patients. Endoscopic ultrasonography revealed hypoechoic, homogeneous and regular bordered structures that originated from the muscularis propria. The size of the leiomyomas ranged between 0.9 × 0.4 and 7.7 × 6.0 cm, respectively. Follow-up investigation revealed significant increase in size in only one patient after a period of 12 months. No correlation between clinical symptoms and size of the leiomyomas could be obtained. Surgery was performed in 6 patients. In 5 cases, endoscopic and endosonographic diagnosis of leiomyoma was confirmed by surgery and histology, respectively. However, in one patient surgery did not confirm esophageal leiomyomas but revealed a bronchial cycst. It is concluded that leiomyoma of the esophagus and stomach can be detected reliably by EUS and show a low tendency of growth. Therefore, it appears to be sufficient to control uncomplicated leiomyomas after a period of 24 months.

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  1. B. Schumacher

    Present address: Department of gastroenterology, Hepatology and Infectiology, Heinrich-Heine-University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany

Authors and Affiliations

  1. Department of gastroenterology, Hepatology and Infectiology, Heinrich-Heine-University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany

    T. Frieling, H. Lübke & D. Häussinger

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  1. B. Schumacher
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Schumacher, B., Frieling, T., Lübke, H. et al. Diagnostic et surveillance de leiomyomes œsophagiens et gastriques par ultrasonographie endoscopique (USE). Acta Endosc 25, 425–431 (1995). https://doi.org/10.1007/BF02966474

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  • DOI: https://doi.org/10.1007/BF02966474

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