The importance of endoscopic ultrasonography in the management of low‐grade gastric mucosa‐associated lymphoid tissue lymphoma

Abstract

Summary Background : Anti‐Helicobacter pylori therapy has been reported to cause regression of low‐grade gastric mucosa‐associated lymphoid tissue lymphoma in a high percentage of patients. However, in some patients, these lesions persist despite antibiotic treatment. Aim : To determine the various endosonographic findings that may predict the regression of low‐grade gastric mucosa‐associated lymphoid tissue lymphoma post‐antibiotics. Methods : Seventy‐six patients with Helicobacter pylori‐positive gastric mucosa‐associated lymphoid tissue lymphoma were studied. Follow‐up data were available on 51 patients. All patients were treated with antibiotics. Participants underwent pre‐ and post‐anti‐Helicobacter pylori therapy endoscopy with gastric biopsies, followed by endoscopic ultrasonography examination of the stomach. Results : Helicobacter pylori was eradicated in 45 of 51 (88%) patients. At the 2‐year follow‐up, complete regression of mucosa‐associated lymphoid tissue lymphoma was seen in 28 of 51 (55%) patients: 12 of 16 (75%) patients in stage T1m N0, 11 of 19 (58%) patients in stage T1sm N0, four of eight (50%) patients in stages T1m N1 and T1sm N1, and one of four (25%) patients in stage T2 N0. None of the stage T2 N1 patients achieved clinical regression. Conclusions : Endoscopic ultrasonography evaluation of gastric mucosa‐associated lymphoid tissue lymphoma plays a pivotal role in the initial staging and post‐treatment follow‐up evaluation of these lesions. Accurate staging is essential in the determination of the optimal treatment modality.

Review of the molecular profile and modern prognostic markers for gastric lymphoma: How do they affect clinical practice?

“…83 Careful and periodic follow-up of patients is highly encouraged: endoscopic ultrasonography and gastric biopsies can detect any relapses early on, allowing these patients to switch to an alternative therapy. 84,85 However, it has been suggested that organ-preserving treatments present the same survival rates as surgical treatment, indicating that primary stomach resection should be questioned. 83 To achieve the best therapeutic result, the surgeon must be aware of the factors that influence the effectiveness of therapeutic interventions.…”

EUS in the Evaluation of Gastric Tumors

“…Further remission was achieved with chlorambucil monochemotherapy in 58% of patients who did not respond to anti-H. pylori treatment. In the multicentric Italian study by Caletti et al, 96 51 patients with low-grade MALT lymphomas were staged using the TNM classification. After antibiotic treatment, eradication of H. pylori was seen in 45 (88%) of the 51 patients.…”

“…In general, for patients who have a persistently thickened gastric wall on EUS despite adequate antibiotic therapy, other treatment modalities should be considered, even if endoscopic biopsy results are negative, because the likelihood of persistent lymphoma or recurrence is high. 96 Most of the studies on EUS done for pretreatment staging of gastric MALT lymphoma agree on the importance of EUS for follow-up. However, given the relative lack of long-term followup series, issues of exactly when and how often to perform EUS, as well as exact clinical and histologic correlations with EUS, are still under debate.…”

Molecular subtyping of gastric MALT lymphomas: implications for prognosis and management

“…36 33 Endoscopic ultrasound is increasingly being used in follow up as an adjunct to endoscopy and biopsy. 37 Lack of response or stable disease at one year is usually considered an indication for radiotherapy or chemotherapy. Where H pylori treatment leads to complete regression, relapse occurs in less than 10% of cases, and given the indolence of the disease the necessity for continued follow up is debateable, especially in the elderly.…”