Diagnostic Yield of Endoscopy after Upper Gastrointestinal Tract Abnormality Found on Computed Tomography
J Chia, L Shimwell, C Bano, D Neal, D Howlett
Hong Kong J Radiol 2019;22:235-42
https://doi.org/10.12809/hkjr1916907
Introduction: The aim of this study was to evaluate the diagnostic yield of endoscopy after upper gastrointestinal (GI) tract abnormality was found on computed tomography (CT) scan.
Methods: Retrospective identification of upper GI endoscopy performed with an indication of “abnormal CT” in a 3-year period. Cases were grouped according to clinical suspicion of underlying GI tract pathology (“expected” or “unexpected”). CT report findings were categorised into one of four categories: dilatation, lymphadenopathy, mass lesion or mural thickening and compared with the main endoscopic finding. Where available, histology was included.
Results: Of 96 patients undergoing upper GI endoscopy after abnormal CT, 14 (15%) had normal examinations. 17 (18%) of 96 patients were found to have an underlying neoplasm (adenocarcinoma, squamous cell carcinoma or lymphoma) of which seven were unexpected clinically. Six (6%) of 96 patients were found to have Barrett’s oesophagus. In five (83%) of six patients with Barrett’s, there was no clinical suspicion for GI tract pathology. A correlative endoscopic abnormality was found in five (45%) of 11 masses where GI pathology was expected compared with eight (40%) of 20 masses when unexpected. Where thickening was reported on CT, a correlative endoscopic abnormality was found in 14 (63%) of 22 patients with expected GI tract pathology compared with 13 (62%) of 21 patients when unexpected.
Conclusions: The diagnostic yield of endoscopy for significant GI tract pathology performed after CT is high and merits further investigation.
Author affiliation(s):
J Chia: Radiology Department, Eastbourne District General Hospital, Eastbourne, United Kingdom
L Shimwell, C Bano, D Howlett: Imaging Department, Eastbourne District General Hospital, Eastbourne, United Kingdom
D Neal: Gastroenterology Department, Eastbourne District General Hospital, Eastbourne, United Kingdom
中文摘要
電腦斷層掃描中發現上胃腸道異常後內窺鏡檢查的診斷陽性率
J Chia、L Shimwell、C Bano、D Neal、D Howlett
引言：本研究旨在評估在電腦斷層掃描（CT）中發現上胃腸道異常後內窺鏡檢查的診斷陽性率。
方法：回顧性分析3年內因「CT顯示異常徵狀」而進行上胃腸道內窺鏡的病例。根據臨床懷疑有潛在胃腸道病變與否（「預期內」或「意外」）對病例進行分組。CT報告的發現分為四類：擴張、淋巴結腫大、腫塊病變或壁增厚，並與主要內窺鏡檢查結果進行比較。在可能的情況下納入組織學結果。
結果：於CT檢查發現異常後接受上胃腸道內窺鏡檢查的96例中，14例（15%）的檢查結果顯示正常。17例（18%）發現患有腫瘤（腺癌、鱗狀細胞癌或淋巴瘤），其中7例屬臨床上意外診斷。此外，96個病例中6例（6%）被發現有Barrett食管，其中5例（83%）沒有臨床懷疑胃腸道病變。在預期有胃腸道病變的11個腫塊中，5個（45%）於內窺鏡發現相關異常。在意外病例中，20個腫塊中有8個（40%）於內窺鏡發現相關異常。當CT發現壁增厚，22例預期胃腸道病理中發現14例（63%）相關內窺鏡檢查異常，而21病例中則發現13例（62%）意外內窺鏡異常。
結論：內窺鏡檢查對CT術後胃腸道顯著病變的診斷陽性率較高，值得檢查。