Clin Endosc.  2018 May;51(3):215-221. 10.5946/ce.2017.170.

Contrast Enhanced Harmonic Endoscopic Ultrasound: A Novel Approach for Diagnosis and Management of Gastrointestinal Stromal Tumors

• Chhoda A
• Jain D
• Surabhi VR
• Singhal S

• KMID: 2414861
• DOI: http://doi.org/10.5946/ce.2017.170

Abstract

The histologic analysis of gastrointestinal stromal tumors (GISTs) is a common method to detect the mitotic activity and to subsequently determine the risk of GISTs for malignancy. The potential false negative error due to inadequate yield of specimens and actual determination of malignancy risk requires analysis of the whole tumor. We aimed to assess the role of contrast enhanced endoscopic ultrasound (CE-EUS) in the management of GISTs. Two authors individually did review of English literatures to identify nine peer-reviewed original articles using keywords- contrast endoscopic ultrasound, GIST and submucosal tumor. Studies were heterogeneous in their aims looking either at differentiating submucosal lesions from GISTs, estimating malignant potential of GISTs with histologic correlation or studying the role of angiogenesis in malignant risk stratification. CE-EUS had moderate to high efficacy in differentiating GISTs from alternative submucosal tumors. CE-EUS had a higher sensitivity than EUS-guided fine needle aspiration, contrast computed tomography and Doppler EUS for detection of neo-vascularity within the GISTs. However, the evidence of abnormal angiogenesis within GIST as a prognostic factor needs further validation. CE-EUS is a non-invasive modality, which can help differentiate GISTs and provide valuable assessment of their perfusion patterns to allow better prediction of their malignant potential but more experience is needed.

Keyword

Gastrointestinal stromal tumors; Contrast enhanced harmonic imaging; Endoscopic ultrasound

MeSH Terms

Biopsy, Fine-Needle
Diagnosis*
Gastrointestinal Stromal Tumors*
Methods
Perfusion
Ultrasonography*

Figure

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  Fig. 1. Endoscopic view of submucosal tumor.

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  Fig. 2. Contrast enhanced computed tomography axial image showing a well-circumscribed submucosal lesion along the lesser curvature of the stomach without necrosis.

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  Fig. 3. Endoscopic ultrasound with Doppler showing vascular flow.

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  Fig. 4. Contrast enhanced harmonic endoscopic ultrasound dual image at the start of contrast administration- left image representing contrast image and the right image representing a tissue image.

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  Fig. 5. Contrast enhanced harmonic endoscopic ultrasound images immediately after contrast administration- neo-vascularity (red arrow) in the submucosal lesion.

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  Fig. 6. Contrast enhanced harmonic endoscopic ultrasound images at 30 seconds after contrast administration- intense enhancement of the submucosal lesion.

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  Fig. 7. Contrast enhanced harmonic endoscopic ultrasound images at 39 seconds after contrast administration- further enhancement of the submucosal lesion.

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  Fig. 8. Contrast enhanced harmonic endoscopic ultrasound images depicting focal area of necrosis within the submucosal lesion.

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  Fig. 9. Contrast enhanced harmonic endoscopic ultrasound images at 60 seconds after contrast administration- washout of the submucosal lesion.

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