Clinical approach to gastrointestinal wall thickening: A prospective single center study

Yıl 2012, , - , 01.08.2012

Bilal Ergül Levent F&#;l&#;k

https://doi.org/10.17940/endoskopi.74827

Öz

Background and Aims:Computerized tomography and ultrasonography are frequently performed for a variety of abdominal complaints. Clinical guideli-nes are lacking regarding endoscopic procedures when gastrointestinal lumi-nal wall thickening is reported on radiologic procedures. Materials and Met-hods: A prospective study was done from January 2010 to July 2012 on pa-tients referred to the Gastroenterology Department of Ankara Education and Research Hospital for incidental gastrointestinal luminal wall thickening on computerized tomography and ultrasonography during the study period. Age, gender, radiologic abnormality and thickening location, endoscopic fin-dings, hematologic parameters, and pathologic data were collected. Results: 129 patients (80 female, 49 male) with gastrointestinal wall thickening who proceeded to endoscopy were identified. The average age of the patients was 20-90 years (mean, 59.78 years). Gastrointestinal luminal wall thickenings were distributed along the gastrointestinal tract as follows: 60 upper (esopha-geal, gastric, and duodenum) and 52 lower (colon and ileum). Seventeen (28.3%) of the upper gastrointestinal and 32 (46.4%) of the lower gastroin-testinal tract wall thickenings were malignant conditions. 92.9% (13/14) of patients with gastric adenocarcinoma and 96.9% (31/32) of patients with co-lorectal adenocarcinoma were older than 50 years. 73.3% of patients with a hemoglobin level less than 12 mg/dl had neoplastic findings in the upper gas-trointestinal tract and 72.3% in the lower gastrointestinal tract. Conclusions: We conclude that gastrointestinal luminal wall thickening is an important ra-diologic finding and could be the initial presentation of malignancy, particu-larly in patients older than 50 and with hemoglobin level less than 12 mg/dl. Endoscopic evaluation should be strongly recommended in patients with gas-trointestinal luminal wall thickening determined on radiologic procedures.

Anahtar Kelimeler

Gastrointestinal luminal wall thickening, endoscopy, colonoscopy, adenocarcinoma

Gastrointestinal duvar kalınlığına yaklaşım: Prospektif tek merkezli çalışma

Öz

Giriş ve Amaç:Çeşitli abdominal şikayetler ile başvuran hastalarda ultrasonografi ve bilgisayarlı tomografi yaygın olarak kullanılmaktadır. Radyolojik yöntemlerde saptanan gastrointestinal sisteme ait duvar kalınlaşması sapta-nan olgularda yaklaşım ve algoritma ile ilgili ortak kabul görmüş bir konsen-sus yoktur.Gereç ve Yöntem:Ocak 2010- Temmuz 2012 tarihleri arasında Ankara E¤itim ve Araştırma Hastanesi Gastroenteroloji Bölümünde, herhangi bir nedenden dolayı abdominal ultrasonografi veya bilgisayarlı tomografi çe-kilen ve gastrointestinal sistem luminal kalınlaşma rapor edilerek endoskopi veya kolonoskopi yapılan hastaların verileri prospektif olarak toplandı. Has-taların yaşları, cinsiyetleri, hematolojik parametreleri, radyolojik incelemede-ki kalınlaşma tespit edilen bölgenin lokalizasyonu, endoskopi ve kolonosko-pi bulguları, patoloji sonuçları ve elde edilen tanıları not edildi.Bulgular: Gastrointestinal sistem duvar kalınlı¤ı saptanan ve takibinde endoskopik in-celeme yapılabilen toplam 129 hasta (49 erkek, 80 kadın) çalışmaya dahil edildi. Hastaların ortalama yaşı 59.78 (20-90,±16.13) idi. Ortalama hemog-lobin düzeyi 12.31 mg/dl (5.8-16.9, ±2.35) olarak bulundu. 60 hastada üst gastrointestinal sistem (özofagus, mide), 69 hastada ise alt gastrointestinal sis-tem (ileum, kolon) duvar kalınlı¤ı saptandı. Üst gastrointestinal sistemde du-var kalınlı¤ı saptanan hastaların 17'sinde (%28.3), alt gastrointestinal sistem-dekilerin ise 32'sinde (%46.4) malign hastalıklar saptandı. Mide adenokarsi-nomlarının %92.9'u (13/14), kolorektal adenokarsinomlarının %96.9'u (31/32) 50 yaşın üzerindeydi. Hemoglobin düzeyi 12.0 mg/dl'nin altında olan olgular incelendi¤inde, üst gastrointestinal sistem duvar kalınlı¤ı sapta-nanların %73,3'ünde, alt gastrointestinal sisteme ait duvar kalınlı¤ı saptanan-ların %72.3'ünde adenokarsinom tespit edilmiştir. Sonuç:Gastrointestinal sistem duvar kalınlı¤ı önemli bir radyolojik bulgu olup özellikle 50 yaşın üze-rinde ve hemoglobin düzeyi 12'nin altında olan hastalarda neoplastik hasta-lıkların ilk bulgusu olabilir. Radyolojik yöntemlerde gastrointestinal sistem duvar kalınlı¤ı saptanan hastalara mutlaka endoskopik de¤erlendirme öneril-melidir.

Anahtar Kelimeler

Gastrointestinal duvar kalınlaşması, endoskopi, kolonoskopi, adenokarsinom

Kaynakça

• Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 2001;176:1105-16.
• Cai Q, Baumgarten DA, Affronti JP, et al. Incidental findings of thicke- ning luminal gastrointestinal organs on computed tomography: an abso- lute indication for endoscopy. Am J Gastroenterol 2003;98:1734-37.
• Karim MS, Miranda MC, Shamma'a JM, et al. Utility of upper endoscopy and colonoscopy in evaluating gastrointestinal luminal wall thickening found on computed tomography. W V Med J 2010;106:16-9.
• Tellez-Avila FI, García-Osogobio S, Chavez-Tapia NC, et al. Utility of en- doscopy in patients with incidental gastrointestinal luminal wall thicke- ning detected with CT. Surg Endosc 2009;23:2191-6.
• Bleibel W, Guerrero JE, Kim S, et al. The clinical significance of inciden- tal computer tomography finding of gastrointestinal luminal wall thicke- ning as evaluated by endoscopy. Dig Dis Sci 2007;52:1709-12.
• Moraitis D, Singh P, Jayadevan R, Cayten CG. Colonic wall thickening on computed tomography scan and clinical correlation. Does it suggest the presence of an underlying neoplasia? Am Surg 2006;72:269-71.
• Wolff JH, Rubin A, Potter JD, et al. Clinical significance of colonoscopic findings associated with colonic thickening on computed tomography: is colonoscopy warranted when thickening is detected? J Clin Gastroente- rol 2008;42:472-5.
• Eskaros S, Ghevariya V, Diamond I, Anand S. Correlation of incidental colorectal wall thickening at CT compared to colonoscopy. Emerg Radi- ol 2009;16:473-6.
• Nicholson BD, Hyland R, Rembacken BJ, et al. Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit? Surg Endosc 2011;25:2586-91.