Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: STOMACH
Purpose: With the increasing number of abdominal CT scans performed for a variety of reasons, more incidental abnormal findings, such as esophageal or gastric wall thickening, are evident. A standard upper endoscopy is frequently performed to evaluate the abnormalities. However, endoscopic ultrasonography (EUS) is a diagnostic modality that can better clarify these reported lesions.
Methods: We retrospectively reviewed all the gastric or gastroesophageal junction EUS examinations performed from January 2000 to August 2004 and identified those whose primary indication was an abnormal gastric wall or gastroesophageal junction thickening on CT scan. All biopsy and fine needle aspiration (FNA) specimens from these procedures were also reviewed and correlated with operative histopathology.
Results: Of the 82 gastric or gastroesophageal junction EUS examinations performed at our institution during the study period, 13 were prompted by an abnormal CT scan. EUS studies were completely normal in 46.1% (6/13) of cases, with no biopsy deemed necessary. Of the remaining 7 patients, 71.4% (5/7) had an abnormal thickening of 1 or multiple gastro/esophageal wall layers, but FNA or well-biopsy revealed only chronic inflammation or reactive gastropathy. There were 2 patients with positive histopathology: the first had a well defined mass arising from the 4th gastric layer (muscularis propria) and had a c-kit positive gastrointestinal stromal tumor confirmed at surgical resection; the second had a mass extrinsic to the stomach but pressing on the gastric wall with FNA positive for neuroendocrine tumor. In both cases of malignancy, a pre-EUS upper endoscopy revealed only a slight bulge in the body of the stomach and prominent antral folds respectively.
Conclusions: Endoscopic ultrasonography with fine needle aspiration is an effective modality to evaluate abnormal gastric and gastroesophageal thickening incidentally identified on abdominal CT scan, and standard upper endoscopy may not be sufficiently sensitive to determine which patients have an underlying malignancy.