Endoscopy 2020; 52(S 01): S207-S208
DOI: 10.1055/s-0040-1704647
ESGE Days 2020 ePoster Podium presentations
Saturday, April 25, 2020 09:30 – 10:00 Upper GI: Endoscopic diagnosis 2 ePoster Podium 6
© Georg Thieme Verlag KG Stuttgart · New York

NON-SPECIFIC UPPER GI MURAL THICKENING ON CT - IS IT JUST FROM PERISTALSIS?

R Patel
Royal Free London NHS Trust, London, UK
,
R Poonawala
Royal Free London NHS Trust, London, UK
,
R Khurram
Royal Free London NHS Trust, London, UK
,
N Jain
Royal Free London NHS Trust, London, UK
,
K Besherdas
Royal Free London NHS Trust, London, UK
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims British Society of Gastroenterology (BSG) guidance on the indications for diagnostic endoscopy include ‘abnormal findings on CT imaging’. Non-specific upper GI mural thickening on CT is a common abnormal finding raising the suspicion of malignancy. The correlation between CT mural thickening in the upper GI tract and endoscopic diagnosis of malignancy is not clearly known.

    Methods Retrospective single centre study of patients referred for gastroscopy with the indication of ´abnormal imaging´ (n=147) from 2016 to 2018. CT reported ´mural thickening´ was included for analysis. Statistics were performed using Welch´s t-test.

    Results 59 patients underwent gastroscopy for CT reported mural thickening: oesophageal 20 (34%), GOJ 9 (15%), gastric 23 (39%), pyloric 4 (7%), duodenal 5 (8%) and jejunal 1 (2%). Median time from CT to endoscopy 21 days (IQR 12 - 54). Median age 77 (IQR 62 - 83).

    11 (19%) patients had a normal gastroscopy, 24 (41%) showed inflammatory changes (oesophagitis or gastritis), 20 (34%) had evidence of a hiatus hernia, and 5 (8%) had benign polyps.

    5 (9%) had a histological diagnosis of gastric adenocarcinoma, 4 (7%) of Barrett´s oesophagus and 1 (2%) of squamous dysplasia.

    Mean haemoglobin for patients with malignancy 104 g/L vs 125 g/L for the overall study group (p=0.13, NS). Mean albumin for patients with malignancy 37.6 g/L vs 38.4 g/L for the overall study group (p=0.81, NS).

    Conclusions Upper GI mural thickening on CT cannot be dismissed. Despite oesophagitis, gastritis and hiatus hernia making up most endoscopic diagnoses (75%), it correlated with malignancy, dysplasia or metaplasia in 10/59 (17%) patients in this study. Patients with malignancy could not be accurately differentiated by indication for imaging or by biochemical markers. There is good concordance in pathology detection at gastroscopy following findings of thickening on CT. We recommend gastroscopy is performed in every case when this abnormality is detected.


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