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Place de l’échoendoscopie dans la prise en charge des tumeurs sous-muqueuses œso-gastriques

Role of endoscopic ultrasound in the management of submucosal tumours in the esophagus and stomach

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Acta Endoscopica

Résumé

Les tumeurs sous-muqueuses œso-gastriques constituent une pathologie rare et de découverte souvent systématique. Elles sont parfois source de complications graves (hémorragie, obstruction) ou peuvent être malignes. L’échoendoscopie apparaît aujourd’hui comme la méthode de choix pour affirmer l’existence d’une lésion sous-muqueuse, et donner des éléments d’orientation sur sa nature, et son pronostic. Elle doit donc prendre place d’emblée après l’examen qui évoque le diagnostic (en général la gastroscopie). Une fois le diagnostic de tumeur sous-muqueuse affirmé, la décision thérapeutique dépend des symptômes, de la localisation et des données échoendoscopiques (taille supérieure à 3 cm, caractère régulier ou non des contours périphériques, homogénéité). Pour des lésions suspectes ou symptomatiques, l’attitude doit être chirurgicale. En cas de lésion régulière, homogène, de petite taille et asymptomatique, une simple surveillance peut-être proposée. Dans les autres situations, il faut favoriser la résection chirurgicale de type énucléation ou la résection endoscopique.

Summary

Esophageal and gastric submucosal tumours are a rare entity, often discovered by systematic endoscopy, indicated for other reasons. They can cause severe haemorrhage, dysphagia or be malignant. Endoscopic ultrasound is at present the best method to confirm the presence of a submucosal lesion, and bring information about its nature and its prognosis. Therefore it has to be performed immediately after endoscopy, usually being the first diagnostic tool. After the lesion has been demonstrated, its management will depend upon symptoms, location (esophagus, stomach) and ultrasound criteria (size superior to 3 cm, well or ill-defined boundaries, homogeneous echopattern). For symptomatic or possible malignant tumour, surgery must be performed. When the lesion is small, homogeneous, well-limited and asymptomatic, simple follow-up can be proposed. In other cases, surgical or endoscopic local resection must be preferred.

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Author notes

  1. J. C. Souquet

    Present address: Hépato-gastroentérologie, Hôpital de la Croix-Rousse, 93, Grande-Rue de la Croix-Rousse, 69317, Lyon Cedex 04

Authors and Affiliations

  1. Hépato-gastroentérologie, Hôpital de la Croix-Rousse, 93, Grande-Rue de la Croix-Rousse, 69317, Lyon Cedex 04

    R. Bobichon

  2. Fédération des Spécialités Digestives, Hôpital E Herriot, Lyon, France

    J. C. Souquet & R. Bobichon

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  1. J. C. Souquet
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Souquet, J.C., Bobichon, R. Place de l’échoendoscopie dans la prise en charge des tumeurs sous-muqueuses œso-gastriques. Acta Endosc 26, 307–312 (1996). https://doi.org/10.1007/BF02968842

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  • DOI: https://doi.org/10.1007/BF02968842

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