Title: 7171 Pesky findings on endoscopy or ct scan: endoscopic ultrasound can help.
Abstract: Endoscopists often encounter submucosal lesions of unknown significance during endoscopy or are asked to evaluate thickened esophageal, stomach or bowel wall noted on CT scan. Endoscopic ultrasound (EUS) has proved useful in defining submucosal and extraluminal structures. The purpose of this study is to determine whether these often incidentally noted abnormalities represent clinically significant entities and to determine whether the addition of EUS changes management or avoids further evaluation. MethodsAll charts from patients undergoing EUS at Virginia Mason Medical Center between December 1998 and November 1999 were evaluated retrospectively. Patients were included if the procedure was performed because of a nonspecific abnormality seen on endoscopy (thick folds, submucosal nodules or extrinsic compression) or CT scan (thickened gut wall). Patients whose abnormalities were highly suspicious for malignant neoplasm were excluded. Charts were evaluated for patient's age, sex and symptoms which initiated the evaluation. EUS findings and subsequent treatment were noted. ResultsOf 292 EUS procedures, 33 (11%) were performed because of an ambiguous finding on endoscopy or CT scan. Of these, 10 patients (30%) had clinically significant findings, 4 (12%) of whom had malignant neoplasms (61 y/o female with gastric cancer, 45 y/o female with periappendiceal carcinoid tumor, 45 y/o male and 61 y/o male with gastric leiomyosarcomas). One patient was completely asymptomatic. Other clinically significant findings included small leiomyomas which will require follow up, adenopathy, a prolapsing pancreatic rest and a lymphangiectatic cyst. In all other patients, EUS was able to determine that the abnormality represented a benign process requiring no further evaluation. Findings included lipomas, pancreatic rests, large adjacent vessels causing compression and thicked mucosa due to inflammation without underlying abnormality. ConclusionEUS is useful in evaluating "incidental" abnormalities found on endoscopy and CT scan. All of the patients could be diagnosed with confidence. Clinically significant findings were seen in 30%, including 12% with malgnant neoplasms. Age, sex and symptoms did not distinguish benign from malignant processes. Endoscopists often encounter submucosal lesions of unknown significance during endoscopy or are asked to evaluate thickened esophageal, stomach or bowel wall noted on CT scan. Endoscopic ultrasound (EUS) has proved useful in defining submucosal and extraluminal structures. The purpose of this study is to determine whether these often incidentally noted abnormalities represent clinically significant entities and to determine whether the addition of EUS changes management or avoids further evaluation. MethodsAll charts from patients undergoing EUS at Virginia Mason Medical Center between December 1998 and November 1999 were evaluated retrospectively. Patients were included if the procedure was performed because of a nonspecific abnormality seen on endoscopy (thick folds, submucosal nodules or extrinsic compression) or CT scan (thickened gut wall). Patients whose abnormalities were highly suspicious for malignant neoplasm were excluded. Charts were evaluated for patient's age, sex and symptoms which initiated the evaluation. EUS findings and subsequent treatment were noted. ResultsOf 292 EUS procedures, 33 (11%) were performed because of an ambiguous finding on endoscopy or CT scan. Of these, 10 patients (30%) had clinically significant findings, 4 (12%) of whom had malignant neoplasms (61 y/o female with gastric cancer, 45 y/o female with periappendiceal carcinoid tumor, 45 y/o male and 61 y/o male with gastric leiomyosarcomas). One patient was completely asymptomatic. Other clinically significant findings included small leiomyomas which will require follow up, adenopathy, a prolapsing pancreatic rest and a lymphangiectatic cyst. In all other patients, EUS was able to determine that the abnormality represented a benign process requiring no further evaluation. Findings included lipomas, pancreatic rests, large adjacent vessels causing compression and thicked mucosa due to inflammation without underlying abnormality. ConclusionEUS is useful in evaluating "incidental" abnormalities found on endoscopy and CT scan. All of the patients could be diagnosed with confidence. Clinically significant findings were seen in 30%, including 12% with malgnant neoplasms. Age, sex and symptoms did not distinguish benign from malignant processes.
Publication Year: 2000
Publication Date: 2000-04-01
Language: en
Type: article
Indexed In: ['crossref']
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