Article ; Online: Significance of thickening of the upper gastrointestinal tract on cross sectional imaging: Endoscopic correlation.
2022 Volume 48, Issue 10, Page(s) 2127–2131
Abstract: Aim: To report the endoscopic findings for a cohort of patients referred for discussion at a specialist oesophago-gastric multi-disciplinary team (MDT) meeting, on the basis of CT mural thickening.: Patients and methods: The records of patients ... ...
Abstract | Aim: To report the endoscopic findings for a cohort of patients referred for discussion at a specialist oesophago-gastric multi-disciplinary team (MDT) meeting, on the basis of CT mural thickening. Patients and methods: The records of patients discussed at a regional oesophago-gastric MDT during the time 1 Results: 456 patients were referred for discussion, 126 met the inclusion criteria. Endoscopy confirmed malignancy in 50/126 patients (40%); by site, oesophagus (21/67, 31%), stomach (25/50, 50%), duodenum (4/9, 44%). Malignancy was confirmed for 10/48 (21%) patients with isolated wall thickening, for 11/33 (33%) when regional lymphadenopathy was identified, and for 28/44 (64%) when possible metastatic disease was identified. The commonest source of diagnostic uncertainty was thickening around the gastro-oesophageal junction in the presence of a hiatal hernia. Wall thickening >20 mm was strongly associated with malignancy compared to thickening =<20 mm (p < 0.0001). Using this threshold would have resulted in a sensitivity of 32/50 (64%), a specificity of 55/76 (72%), a positive predictive value of 32/53 (60%) and a negative predictive value of 55/73 (75%) in this cohort. Conclusions: The cancer pick-up rate of 40% and the medicolegal consequences of a missed cancer suggest that endoscopy should be performed in all patients with CT identified mural thickening. In the presence of isolated mural thickening and a normal endoscopy, no formal MDT discussion is required. |
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MeSH term(s) | Humans ; Cross-Sectional Studies ; Upper Gastrointestinal Tract/diagnostic imaging ; Esophagogastric Junction/diagnostic imaging ; Esophagus ; Endoscopy, Gastrointestinal |
Language | English |
Publishing date | 2022-06-04 |
Publishing country | England |
Document type | Journal Article |
ZDB-ID | 632519-1 |
ISSN | 1532-2157 ; 0748-7983 |
ISSN (online) | 1532-2157 |
ISSN | 0748-7983 |
DOI | 10.1016/j.ejso.2022.05.027 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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