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Impellizzeri G, Donato G, De Angelis C, Pagano N. Diagnostic Endoscopic Ultrasound (EUS) of the Luminal Gastrointestinal Tract. Diagnostics (Basel) 2024; 14:996. [PMID: 38786295 PMCID: PMC11120241 DOI: 10.3390/diagnostics14100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
The purpose of this review is to focus on the diagnostic endoscopic ultrasound of the gastrointestinal tract. In the last decades, EUS has gained a central role in the staging of epithelial and sub-epithelial lesions of the gastrointestinal tract. With the evolution of imaging, the position of EUS in the diagnostic work-up and the staging flow-chart has continuously changed with two extreme positions: some gastroenterologists think that EUS is absolutely indispensable, and some think it is utterly useless. The truth is, as always, somewhere in between the two extremes. Analyzing the most up-to-date and strong evidence, we will try to give EUS the correct position in our daily practice.
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Affiliation(s)
| | | | | | - Nico Pagano
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (G.I.); (C.D.A.)
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Sato R, Matsumoto K, Kanzaki H, Matsumi A, Miyamoto K, Morimoto K, Terasawa H, Fujii Y, Yamazaki T, Uchida D, Tsutsumi K, Horiguchi S, Kato H. Gastric linitis plastica with autoimmune pancreatitis diagnosed by an endoscopic ultrasonography-guided fine-needle biopsy: A case report. World J Clin Cases 2022; 10:11607-11616. [PMID: 36387831 PMCID: PMC9649568 DOI: 10.12998/wjcc.v10.i31.11607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastric linitis plastica (GLP) is a subset of gastric cancer with a poor prognosis. It is difficult to obtain a definitive diagnosis by endoscopic mucosal biopsies, and the usefulness of an endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) for GLP has been recently reported. Meanwhile, autoimmune diseases are occasionally known to coexist with malignant tumors as paraneoplastic syndrome. We herein report the usefulness of an EUS-FNB for detecting GLP and the possibility of paraneoplastic syndrome coexisting with GLP.
CASE SUMMARY An 81-year-old man was admitted to our hospital for a 1-mo history of epigastric pain that increased after eating. His laboratory data revealed high levels of serum carbohydrate antigen 19-9 and immunoglobulin-G4. Endoscopic examinations showed giant gastric folds and reddish mucosa; however, no epithelial changes were observed. The gastric lumen was not distensible by air inflation, suggesting GLP. Computed tomography showed the thickened gastric wall, the diffuse enlargement of the pancreas, and the peripancreatic rim, which suggested autoimmune pancreatitis (AIP) coexisting with GLP. Because the pathological findings of the endoscopic biopsy showed no malignancy, he underwent an EUS-FNB and was diagnosed with GLP. He received chemotherapy for unresectable gastric cancer due to peritoneal metastasis, after which both the gastric wall thickening and diffuse enlargement of the pancreas were improved.
CONCLUSION An EUS-FNB for GLP with a negative endoscopic biopsy is useful, and AIP may develop as a paraneoplastic syndrome.
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Affiliation(s)
- Ryosuke Sato
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kazuyuki Matsumoto
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Hiromitsu Kanzaki
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Akihiro Matsumi
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kazuya Miyamoto
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kosaku Morimoto
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Hiroyuki Terasawa
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Yuki Fujii
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Tatsuhiro Yamazaki
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Daisuke Uchida
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Koichiro Tsutsumi
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Shigeru Horiguchi
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Hironari Kato
- Gastroenterology and Hepatology, Okayama University Hospital, Okayama 700-8558, Japan
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Assaf A, Terris B, Palmieri LJ, Rouquette A, Beuvon F, Pellat A, Ali EA, Ginestet C, Belle A, Dhooge DM, Brezault DC, Hallit R, Dohan A, Chaussade S, Coriat R, Barret M. Endoscopic ultrasound guided fine needle biopsy in patients with suspected gastric linitis plastica. Clin Res Hepatol Gastroenterol 2022; 46:101903. [PMID: 35301155 DOI: 10.1016/j.clinre.2022.101903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastric linitis plastica (GLP) is a diffuse infiltrating type of gastric adenocarcinoma. It is associated with a poor prognosis and a five-year survival of 3-10%. The infiltrating profile of this tumor explains the low yield of the superficial mucosal biospies. The objective of this study was to investigate the role of endoscopic ultrasound-fine needle biopsy (EUS-FNB) in the diagnosis of GLP. METHODS We performed a retrospective analysis including all patients who had an EUS-FNB, at a tertiary referral center, over the last 3 years. The primary outcome was the sensitivity of EUS-FNB in patients with suspected GLP. RESULTS Between January 2017 and December 2020, 34 patients had an EUS-FNB for suspected GLP. Ten patients had a diagnostic of GLP. This diagnosis was obtained by EUS-FNB in 90% (9/10) of the cases. Eight patients had at least one previous esophagogastroduodenoscopy (EGD) with negative mucosal biopsies. Gastric EUS-FNB helped diagnose other serious conditions in 47% (16/34) of cases with inconclusive mucosal biopsies. CONCLUSION Gastric EUS-FNB in patients with suspected GLP and normal endoscopic mucosal biopsies may lead to a positive diagnosis of GLP in 90% of cases without notable adverse events. This technique should be considered as a second step in the setting of suspicion of GLP after inconclusive mucosal biopsies.
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Affiliation(s)
- Antoine Assaf
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France.
| | - Benoit Terris
- Departement of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Lola-Jade Palmieri
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Alexandre Rouquette
- Departement of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Frédéric Beuvon
- Departement of Pathology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Anna Pellat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Claire Ginestet
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Dr Marion Dhooge
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Dr Catherine Brezault
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Anthony Dohan
- Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75014 Paris, France; Faculté de Médicine Paris Centre, Université de Paris, 75006 Paris, France
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Okamoto T, Suzuki H, Fukuda K. Gastric linitis plastica due to signet-ring cell carcinoma with Krukenberg tumors diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2021; 14:994-1003. [PMID: 33740238 DOI: 10.1007/s12328-021-01387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
Gastric linitis plastica is a rare condition characterized by the stiffening and thickening of the gastric wall, presenting a "leather bottle" appearance. It is generally associated with infiltration of poorly differentiated gastric cancer cells, but similar findings can arise due to metastases from other cancers and benign inflammatory processes. Despite advances in imaging modalities, pathological evaluation is required for diagnosis. As endoscopic mucosal biopsies may not be diagnostic, endoscopic ultrasound-guided fine-needle aspiration of the thickened stomach wall presents a potential diagnostic option. We report a case which presented with bilateral ovarian tumors and was ultimately diagnosed as gastric signet-ring cell carcinoma with Krukenberg tumors by endoscopic ultrasound-guided fine-needle aspiration of the stomach wall. The preoperative diagnosis allowed the patient to avoid surgery and to start chemotherapy for gastric cancer. We also review the existing literature on endoscopic ultrasound-guided fine-needle aspiration in the context of gastric linitis plastica.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan. .,Department of Gastroenterology and Hepatology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
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Díaz Del Arco C, Ortega Medina L, Estrada Muñoz L, García Gómez de Las Heras S, Fernández Aceñero MJ. Is there still a place for conventional histopathology in the age of molecular medicine? Laurén classification, inflammatory infiltration and other current topics in gastric cancer diagnosis and prognosis. Histol Histopathol 2021; 36:587-613. [PMID: 33565601 DOI: 10.14670/hh-18-309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastric cancer (GC) is the fifth most common cancer and the third cause of cancer-related deaths worldwide. In western countries, more than half of GC patients are diagnosed at advanced stages and 5-year survival rates range between 20-30%. The only curative treatment is surgery, and despite recent advances in oncological therapies, GC prognosis is still poor. The main prognostic tool for patient categorization and treatment selection is the TNM classification, but its limitations are being increasingly recognized. Early recurrences may occur in early-stage disease, and patients at the same stage show heterogeneous outcomes. Thus, there is a need to improve GC stratification and to identify new prognostic factors, which may allow us to select drug-susceptible populations, refine patient grouping for clinical trials and discover new therapeutic targets. Molecular classifications have been developed, but they have not been translated to the clinical practice. On the other hand, histological assessment is cheap and widely available, and it is still a mainstay in the era of molecular medicine. Furthermore, histological features are acquiring new roles as reflectors of the genotype-phenotype correlation, and their potential impact on patient management is currently being analyzed. The aim of this literature review is to provide a modern overview of the histological assessment of GC. In this study, we discuss recent topics on the histological diagnosis of GC, focusing on the current role of Laurén classification and the potential value of new histological features in GC, such as inflammatory infiltration and tumor budding.
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Affiliation(s)
- Cristina Díaz Del Arco
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain. .,Complutense University of Madrid, Madrid, Spain
| | - Luis Ortega Medina
- Complutense University of Madrid, Madrid, Spain.,Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Mª Jesús Fernández Aceñero
- Complutense University of Madrid, Madrid, Spain.,Department of Surgical Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Morgant S, Artru P, Oudjit A, Lourenco N, Pasquer A, Walter T, Gornet JM, Rouquette A, Brezault C, Coriat R. Endoscopic ultrasound efficacy in staging gastric linitis plastica lesion: a retrospective multicentric French study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:50. [PMID: 33553343 PMCID: PMC7859799 DOI: 10.21037/atm-20-3474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/25/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is a key imaging technique in gastric cancer (GC). The aim of this study was to evaluate the performance of EUS in the staging of parietal and lymph node involvement in linitis plastica (LP) compared to "classical" GC. METHODS A retrospective multicentric French study was conducted on patients with no metastatic LP and operated by gastrectomy. A 2/1 matching based on pTNM stage and center was performed with GC. RESULTS Forty-three patients were included, sixteen patients in the LP group and 27 in the control group. Sensitivity and specificity of EUS for diagnosis of T3-T4 parietal invasion were 77% and 100% respectively in the LP group and 89% and 56% respectively in the control group. Sensitivity and specificity of EUS for diagnosis of lymph node involvement were 73% and 80%, respectively in the LP group and 88% and 50%, respectively in the control group. Patients from LP group had significantly more advanced histological lesion, and frequent undiagnosed peritoneal carcinomatosis. CONCLUSIONS This study evaluated for the first time in a European population, the preoperative EUS performance in LP. Our study identified a similar sensitivity and specificity of the EUS in LP compared to "classical" GC paving for a broader use of EUS in preoperative settings.
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Affiliation(s)
- Stephanie Morgant
- Gastroenterology and digestive oncology unit, Hôpital Cochin, Paris, France
| | - Pascal Artru
- Gastroenterology and Digestive Unit, Jean Mermoz Clinic, Lyon, France
| | - Ammar Oudjit
- Radiology Unit, Cochin Teaching Hospital, Paris, France
| | - Nelson Lourenco
- Gastroenterology Unit, Saint-Louis Teaching Hospital, Paris, France
| | - Arnaud Pasquer
- Digestive Surgery Unit, Edouard Herriot Teaching Hospital, Lyon, France
| | - Thomas Walter
- Oncology Unit, Edouard Herriot Teaching Hospital, Lyon, France
| | - Jean-Marc Gornet
- Gastroenterology Unit, Saint-Louis Teaching Hospital, Paris, France
| | | | - Catherine Brezault
- Gastroenterology and digestive oncology unit, Hôpital Cochin, Paris, France
| | - Romain Coriat
- Gastroenterology and digestive oncology unit, Hôpital Cochin, Paris, France
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Diaz LI, Mony S, Klapman J. Narrative review of the role of gastroenterologist in the diagnosis, treatment and palliation in gastric and gastroesophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1106. [PMID: 33145325 PMCID: PMC7575985 DOI: 10.21037/atm-20-4143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer (EC) and gastric cancer (GC) carry a high mortality rate. Unfortunately, a majority of patients are asymptomatic and at the time of diagnosis, the disease may invariably be in its advanced stages with limited curative options. Thus, it is imperative to recognize certain risk factors including gastroesophageal reflux disease (GERD), male gender, pre-existing Barrett’s esophagus, smoking history, obesity, Helicobacter pylori infection, atrophic gastritis among others for both EC and GC, intervene on time with screening and surveillance modalities if indicated and optimize treatment plans. With advances in endoscopic techniques, early neoplastic lesions are increasingly managed by gastroenterologists, offering an alternative to surgery. The gold standard for diagnosis of EC and GC is high definition endoscopy with adequate targeted biopsies. Endoscopic ultrasound (EUS) is a key in the staging of early cancers dictating the pathway for treatment options. We also play a key role in palliation cases with the aim to reduce the symptoms like nausea, vomiting and even when possible, restore oral intake and improve nutrition in both advanced GC and EC. This review article discusses the risk factors, diagnostic and endoscopic treatment modalities of early EC and GC and palliation of advanced cancer where gastroenterologists play a key role.
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Affiliation(s)
- Liege I Diaz
- Department of Endoscopic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Shruti Mony
- Division of Digestive Diseases and Nutrition, University of South Florida, Tampa, FL, USA
| | - Jason Klapman
- Department of Endoscopic Oncology, Moffitt Cancer Center, Tampa, FL, USA
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Song X, Shi Y, Shi T, Liu B, Wei J, Wang J. The efficacy of treating patients with non-metastatic gastric linitis plastica using surgery with chemotherapy and/or radiotherapy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1433. [PMID: 33313178 PMCID: PMC7723551 DOI: 10.21037/atm-20-2785b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background To explore the efficacy of treatment strategies for non-metastatic gastric linitis plastica (GLP). Methods Patients with non-metastatic GLP from 2004 to 2014 were identified from the National Cancer Database (NCDB). We compared overall survival (OS) of those patients who received different treatments, including surgery alone, a combination of surgery with chemotherapy and/or radiotherapy (S + C/R), chemotherapy and/or radiotherapy (C/R), and no treatment. Results The cohort included 474 patients with non-metastatic GLP. Overall, the median survival was significantly different among four groups (13.90 months in S + C/R, 8.38 months in surgery alone, 8.94 months in C/R and 2.50 months in no treatment). Then, we compared the efficacy of surgery alone and surgery with postoperative chemotherapy and/or radiotherapy (S + post C/R). When the tumor size was greater than 8 cm in stage III patients, S + post C/R was associated with a better survival benefit than surgery alone. S + post C/R also conferred an obvious survival advantage compared to surgery alone for R0 patients with positive lymph nodes and patients with positive margins. Conclusions Surgery plays the fundamental role in improving the OS of patients with non-metastatic GLP. S + post C/R would benefit patients in stage III with large-sized tumors (>8 cm), patients with negative margins and positive lymph nodes, and/or patients with positive margins.
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Affiliation(s)
- Xueru Song
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yan Shi
- Department of Oncology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Shi
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Baorui Liu
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jia Wei
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiping Wang
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Liu Y, Chen K, Yang XJ. Endoscopic ultrasound-guided fine-needle aspiration used in diagnosing gastric linitis plastica: Metastatic lymph nodes can be valuable targets. J Gastroenterol Hepatol 2019; 34:202-206. [PMID: 29864202 DOI: 10.1111/jgh.14300] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/10/2018] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The aim of this study was to assess the performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis of gastric linitis plastic (GLP). METHODS We retrospectively reviewed all the cases undergoing EUS for suspected GLP from January 2012 to September 2017. We included patients with GLP confirmed pathologically with white-light endoscopy (WLE)-guided biopsy or EUS-FNA. Diagnostic value of WLE biopsy and EUS-FNA was further analyzed. RESULTS A total of 107 cases of suspected GLP were referred for EUS examination in our center. Twenty-six patients were eligible and included. GLP was confirmed in 15 cases by EUS-FNA, nine cases by WLE biopsy, and eight cases by surgical pathology. The positive rate of EUS-FNA and WLE biopsy for involved gastric wall was 71.43% (15/21) and 47.37% (9/19). EUS-FNA of metastatic lymph nodes was also performed in 16 cases, and 15 (93.75%) were proved to be malignant, including all 13 that were positive for peri-gastric lymph nodes, and two of three (66.67%) that were positive rate for retroperitoneal lymph nodes. Diameters of punctured lymph nodes ranged from 3.30 to 22.70 mm, with an average of 12.12 mm. CONCLUSIONS Pathological diagnosis of GLP by invasive endoscopy is still intractable, even at a late stage. Positive results can be obtained even in small or distant lymph nodes.
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Affiliation(s)
- Yuan Liu
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ke Chen
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiu-Jiang Yang
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Endoscopic ultrasound-guided fine-needle aspiration biopsy for diagnosis of gastric linitis plastica with negative malignant endoscopy biopsies. Oncol Lett 2018; 16:4915-4920. [PMID: 30250557 PMCID: PMC6144711 DOI: 10.3892/ol.2018.9258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 07/17/2018] [Indexed: 12/12/2022] Open
Abstract
The value of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy in the gastric linitis plastica (GLP) with negative malignant endoscopy biopsies was investigated. Forty-six patients with linitis plastica who had undergone EUS-FNA were retrospectively studied, and their clinicopathological data were examined. Among the 46 eligible patients, 38 cases were diagnosed clearly by EUS-FNA. There were 24 cases with lymph node metastasis in the 38 patients. Both the lymph nodes and gastric lesions were punctured by EUS-FNA in the 24 cases. We compared the diagnostic accuracy in different sites, and the results showed that the diagnostic accuracy in lymph nodes was significantly higher than that in gastric lesions (P<0.05). Among them, 16 patients underwent surgical resection, and the accuracy of the pathological diagnosis by EUS-FNA was 87.5% (14/16). The preoperative diagnostic accuracy of T and N staging by endoscopic ultrasound (EUS) were both 75%. Neither severe hemorrhage nor perforation occurred in any patient. In conclusion, EUS-FNA is a safe and effective procedure for the diagnosis of indefinite linitis plastica, and puncturing metastatic lymph nodes can improve the diagnostic accuracy.
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Muraoka S, Tsuchida K, Iwasaki M, Izawa N, Jinnai H, Komatsubara T, Tsunemi M, Sakuma F, Kashima K, Fukushi K, Hiraishi H. A case report of gastric linitis plastica diagnosed by endoscopic ultrasound-guided fine needle aspiration. Medicine (Baltimore) 2017; 96:e8937. [PMID: 29390283 PMCID: PMC5815695 DOI: 10.1097/md.0000000000008937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE There is currently no consensus on the ideal method for obtaining deep tissue biopsy material of advanced gastric LP. EUS-FNA has potential as a useful diagnostic method. Thus, we report the case of a 46-year-old male with advanced gastric linitis plastica (LP) who was diagnosed using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). PATIENT CONCERNS The patient underwent esophagogastroduodenoscopy (EGD) because of epigastric pain at a local clinic. The gastric fold swelling was pointed out by the EGD and despite the suspected advanced gastric LP, biopsy indicated Group 1. Repeat biopsy did not suggest malignancy. The patient was referred to our institution. DIAGNOSES Endoscopic ultrasound indicated gastric wall thickening mainly in the greater curvature of the gastric corpus. Low-level echoes were detected throughout the entire gastric wall, and gastric wall layers had been disappeared. EUS-FNA of the gastric wall indicated signet ring cell carcinoma. INTERVENTIONS As a result of EUS - FNA, it became a policy to administer chemotherapy. In accordance with the patient's wishes, he was referred to another institution for chemotherapy. OUTCOMES Normal biopsy did not give a definitive pathological diagnosis, and final diagnosis of LP was obtained with EUS-FNA. LESSONS We expect that EUS-FNA can be utilized as a relatively non-invasive, highly sensitive, and specific pathological diagnostic procedure for advanced gastric LP. EUS-FNA should be considered as one way to obtain a deep tissue biopsy of advanced gastric LP.
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Chenbhanich J, Malone MV, Spigelman Z, Seetharaman K. Gastric Wall Thickening: Do Not Overlook Family History. Am J Med 2017; 130:e69-e70. [PMID: 28117042 DOI: 10.1016/j.amjmed.2016.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Jirat Chenbhanich
- Department of Internal Medicine, Metrowest Medical Center, Framingham, Mass.
| | | | - Zachary Spigelman
- Division of Hematology and Oncology, Department of Internal Medicine, Metrowest Medical Center, Framingham, Mass; Division of Hematology and Oncology, Department of Medicine, Tufts Medical Center, Boston, Mass
| | - Kala Seetharaman
- Division of Hematology and Oncology, Department of Internal Medicine, Metrowest Medical Center, Framingham, Mass
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PÉRISSÉ LUÍSGUSTAVOSANTOS, ECBC-RJ PAULOCÉZARMARQUESPÉRISSÉ, RIBEIRO KELSONFERREIRA. Gastric wall changes after intragastric balloon placement: a preliminary experience. Rev Col Bras Cir 2016; 43:286-8. [DOI: 10.1590/0100-69912016004011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/30/2016] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective : to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal. Methods : fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia. In all patients, there was infusion of 500ml of distilled water in the balloon for the test. Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water. Results : the presence of IGB led to increased wall thickness of the gastric body by expanding the muscle layer. These changes were apparently transient, since 30 days after the balloon withdrawal there was a tendency to return of the wall thickness values observed before the balloon insertion. Conclusion : the use of intragastric balloon for the treatment of obesity determines transient increase in the wall thickness of the gastric body caused by expanded muscle layer.
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Aggarwal A, Jazayeri MA, Garg S. Just Scratching the Surface: Intractable Nausea and Vomiting. Am J Med 2015; 128:e3-5. [PMID: 26169893 DOI: 10.1016/j.amjmed.2015.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Avin Aggarwal
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minn
| | | | - Shashank Garg
- Division of Digestive Disease and Nutrition, Department of Medicine, University of Kentucky, Lexington.
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