P1461 - Direct Visualization of Upper Gastrointestinal Wall Thickening Reported on Computed Tomography

Grace Hopp, DO, MBA¹, Andrea DeCino, MD², Laura Rosenkranz, MD², Chris Moreau, BSBME^3
1University of Texas Health Science Center San Antonio, San Antonio, TX; ²University of Texas Health Science Center at San Antonio, San Antonio, TX; ³UT Health San Antonio, San Antonio, TX

Introduction: Gastrointestinal wall thickening is a nonspecific, variably reported finding on computed tomography (CT) with no specific guidelines for follow up or management. Our aim was to determine how thickening of the proximal gastrointestinal tract seen on CT correlated with esophagoduodenoscopy (EGD) findings.

Methods: A retrospective chart review was conducted on 336 patients from February 2018 to December 2020 at a single tertiary care center. The patient list was obtained from ProVation, a reporting procedural software, using the indication “Abnormal CT.” All adult patients with CT findings of “thickening” in the esophagus, stomach, or small intestine who underwent subsequent EGD were included in analysis. Patients were excluded if they had a known disorder affecting the proximal gastrointestinal tract or had prior anatomy altering surgeries in the area of reported thickening.


Results: A total of 119 patients were included in the analysis. The most common indications for CT were abdominal pain (53.8%) and nausea or vomiting (28.6%). Endoscopic findings were present in 110 patients (92%), and were primarily in the stomach. The most common findings in all locations were inflammation and ulceration. Biopsies were obtained in 80 patients (67%), and found chronic active gastritis (23.8%; n=19) and adenocarcinoma (23.8%; n=19), irrespective of location of abnormal CT findings. In the data 34% of patients with esophageal thickening on CT had endoscopic findings outside of the esophagus, 33% of patients with gastric thickening on CT had endoscopic findings outside of the stomach, and 56% of patients with duodenal thickening on CT had endoscopic findings outside of the duodenum (Figure 1). Nine patients had normal endoscopy, and only one patient had no pathology on biopsy. In our patient population, almost a third of patients (32.9%; n=39) who had “CT thickening”, underwent EGD and had a malignancy diagnosed on pathology.

Discussion: By location, CT findings generally correlated with endoscopic findings, though there were several incidental findings. This highlights that direct visualization is able to detect findings outside of where CT can.

In almost all locations where biopsies were obtained, there was pathology to be reported, as well as a high incidence of malignancy. This suggests that thickening on CT scan warrants direct visualization and possibly biopsies for further characterization.


Figure: Figure 1: Location of Endoscopic Findings by Location of Thickening on CT

FINDINGS	Esophagus (N=17)	Stomach (N=46)	Duodenum (N=19)
SQUAMOUS CELL CARCINOMA	5.9%	-	-
INVASIVE ADENOCARCINOMA	17.6%	32.6%	5.3%
OTHER MALIGNANCY	-	8.2%	5.3%
HYPERPLASTIC POLYP	-	6.1%	5.3%
INTESTINAL METAPLASIA	5.9%	8.2%	10.5%
SQUAMOCOLUMNAR MUCOSA	-	4.1%	-
HELICOBACTER PYLORI INFECTION	-	12.2%	5.3%
OTHER INFECTION	5.9%	2%	-
CHRONIC ACTIVE GASTRITIS	17.6%	28.6%	21.1%
REACTIVE GASTRITIS	5.9%	12.2%	21.1%
VILLOUS BLUNTING	5.9%	2%	10.5%
PEPTIC DUODENITIS	11.8%	-	15.8%
ACTIVE INFLAMMATION (NONSPECIFIC)	11.8%	10.2%	26.3%
CHRONIC INFLAMMATION (NONSPECIFIC)	23.5%	4.1%	15.8%
OTHER	5.9%	2%	5.3%
NORMAL	-	2%	-

Table: Table 1. BIOPSY RESULTS BY LOCATION OF REPORTED THICKENING ON CT
*Due to multiple findings in each location, cumulative findings may be greater than 100%



Disclosures:
Grace Hopp indicated no relevant financial relationships.
Andrea DeCino indicated no relevant financial relationships.
Laura Rosenkranz indicated no relevant financial relationships.
Chris Moreau indicated no relevant financial relationships.


Grace Hopp, DO, MBA¹, Andrea DeCino, MD², Laura Rosenkranz, MD², Chris Moreau, BSBME³. P1461 - Direct Visualization of Upper Gastrointestinal Wall Thickening Reported on Computed Tomography, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.