The seven-layer stratification theory of gastric wall under ultrasonography and its clinical application

ObjectiveHere, we develop a seven-layer gastric wall stratification theory based on the physical basis of ultrasound and histology, and further discuss its potential clinical application. Methods1. Experimental methods: Ex vivo human gastric specimens were immersed in normal saline and examined with a high-frequency probe to study the relationship between the sonograms and the corresponding anatomy of the gastric wall. 2. The study enrolled 136 patients admitted to our hospital with gastric diseases who underwent gastric contrast ultrasonography supplemented with the pathological examination. The seven-layer stratification theory was adopted during the analysis to profile sonogram characteristics with lesions originating from various layers. ResultsAll the sonograms of the in vitro human gastric specimens could be divided into seven intervals of strong and weak echoes. The pathological examinations were performed on 136 patient-derived samples as the golden criteria of diagnosis: 29 cases of gastric polyps, 10 cases of lymphomas, 5 cases of neuroendocrine tumors, 11 cases of ectopic pancreas, 22 cases of gastric stromal tumor, 19 cases of leiomyomas, 29 cases of chronic inflammation, 9 cases of diffuse invasive cancer, and 2 cases of neurilemmoma. The ultrasound and pathological examination results were consistent in 110 cases, showing a coincidence rate of 80.9%. ConclusionBy adopting the seven-layer stratification theory of the gastric wall, the ultrasound can accurately locate the position of mucosal muscularis, which is of great significance for accurate measurement of the thickness of each anatomical layer and the correct judgment of the origin and the classification of the space-occupying lesions. Keywords Gastric wall; ultrasound; seven-layer stratification; clinical application

Gastric tumorigenesis after radical resection combined with adjuvant chemotherapy for colorectal cancer: two case reports and a literature review

Radical resection with or without adjuvant chemotherapy is a common option for stage II and III colorectal cancer. Few reports exist regarding gastric tumorigenesis, including gastric cancer, gastric intraepithelial neoplasia, and gastric stromal tumor, in patients who received this protocol as the standard treatment for colorectal cancer. We present two cases of gastric tumorigenesis in patients with colorectal cancer following radical resection combined with adjuvant chemotherapy. Both patients underwent gastrectomy and D2 lymphadenectomy for their gastric tumors; neither patient developed recurrence up to 2 years after treatment. These cases indicate that patients should be monitored closely for gastric tumorigenesis after treatment for colorectal cancer. Early detection and active surgical treatment can provide satisfactory results for colorectal cancer followed by gastric tumorigenesis. Long-term follow-up and regular examinations, especially gastroscopy, are necessary to detect gastric tumorigenesis after colorectal cancer. The focus on monitoring colorectal cancer alone in colorectal cancer patients should be changed to include a broader range of cancers in addition to precancers and other tumors, such as gastric stromal tumor.

CT differentiation of gastric ectopic pancreas from gastric stromal tumor

Background Gastric ectopic pancreas (GEPs) is a rare developmental anomaly which is difficult to differentiate it from submucosal tumor such as gastric stromal tumor (GST) by imaging methods. Since the treatments of the GEPs and GST are totally different, a correct diagnosis is essential. Therefore, we retrospectively investigated the CT features of them to help us deepen the understanding of GEPs and GST. Methods This study enrolled 17 GEPs and 119 GST, which were proven pathologically. We assessed clinical and CT features to identify significant differential features of GEPs from GST using univariate and multivariate analyses. Results In univariate analysis, among all clinicoradiologic features, features of age, symptom, tumor marker, location, contour, peritumoral infiltration or fat-line of peritumor, necrosis, calcification, CT attenuation value of unenhancement phase/arterial phase/portal venous phase (CTu/CTa/CTp), the CT attenuation value of arterial phase/portal venous phase minus that of unenhanced phase (DEAP/DEPP), long diameter (LD), short diameter (SD) were considered statistically significant for the differentiation of them. And the multivariate analysis revealed that location, peritumoral infiltration or fat-line of peritumor, necrosis and DEPP were independent factors affecting the identification of them. In addition, ROC analysis showed that the test efficiency of CTp was perfect (AUC = 0.900). Conclusion Location, the presence of peritumoral infiltration or fat-line of peritumor, necrosis and DEPP are useful CT differentiators of GEPs from GST. In addition, the test efficiency of CTp in differentiating them was perfect (AUC = 0.900).

Endoscopic obturation with tissue adhesive for bleeding gastric stromal tumor: a case report

Primary endoscopic hemostasis for bleeding gastrointestinal stromal tumor (GIST) is rarely reported. Herein, we report the case of a patient with a bleeding GIST that was treated with endoscopic obturation with tissue adhesive. A 46-year-old man presented with hematemesis and tarry stool for 1 day. Upper GI endoscopy revealed a bleeding submucosal tumor at the stomach fundus and an exposed pulsatile vessel was seen at the defect. Endoscopic obturation with tissue adhesive was performed to treat the defect and the bleeding was successfully stopped. No recurrence of bleeding was observed through a gastric tube, and 6 days after endoscopic obturation, the patient underwent laparoscopic partial gastrectomy. Endoscopic obturation with tissue adhesive is a feasible and effective method to treat bleeding GIST.