Upper endoscopy versus endosonography in differential diagnosis of gastrointestinal bulging

Abstract

-Context -The identification of a bulging covered by normal epithelium is a common finding during an upper gastrointestinal endoscopy. Objective -To compare the endoscopic and endosonography findings in the differential diagnosis of the gastrointestinal bulging (subepithelial tumor or extrinsic compression). Method -Patients referred by endosonography with bulging of upper gastrointestinal tract were studied retrospectively. The size, location, consistency and presumptive diagnosis were recorded at time of endoscopy and endosonography. Endosonography-guided fine-needle aspiration was proposed in case of uncertain diagnose to increase diagnostic sensitivity. Results -One hundred seventy-six patients (93 women) and mean age 62.5 years (10-87). One hundred fifty-three had subepithelial tumor and 23 had extrinsic compression as a final diagnosis. Endosonography had sensitivity, specificity and accuracy higher than those found by endoscopy for both diagnosis subepithelial tumor and extrinsic compression. Endoscopy and endosonography showed poor concordance (K = 0.13) for subepithelial tumor diagnosis and unsuitable agreement for diagnosis in extrinsic compression (K = 0.01). The endosonography-guided fine-needle aspiration had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 75%, 72.4%, 80.5%, 65.6% and 74%, respectively. Conclusion -Endoscopy has high sensitivity and low specificity for subepithelial tumor and both are low for the extrinsic compression. Endoscopy is a good tool for diagnosis of the subepithelial tumors, but not to determine the cause of an extrinsic compression. The endosonography identifies the layer from which subepithelial tumor comes, obtain histological samples, and increasing the diagnostic accuracy.

Primary isolated asymptomatic gastric tuberculosis of the cardia mimicking gastric stromal tumor: a rare case report and literature review

“…In 2012, Vishal Gupta reported primary gastric TB mimicking a gastrointestinal stromal tumor in the gastric antrum. On EUS, the lesion appeared as a round, well-defined, uniformly hypoechoic lesion occupying the fourth layer of the gastric wall, with no significant perigastric lymphadenopathy [5]. In our case, the intraoperative and EUS manifestations were similar.…”

“…The most common site of gastric TB is the antrum region, especially the lesser curvature near the prepyloric region [3][4][5][6]15]. Additionally, this is the most common site for peptic ulcers, thus resulting in a mucosal breach at this site.…”

“…Clinically, gastric tuberculosis often resembles peptic ulcer disease, cancer or lymphoma under endoscopy [1,2]. There have been several reported cases of gastric TB mimicking a subepithelial tumor or gastrointestinal stromal tumor, but most cases were mainly located in the antrum of the stomach [3][4][5][6]. Gastric tuberculosis in the cardia of the stomach usually appears like a gastric stromal tumor [4].…”

Primary gastric tuberculosis mimicking a submucosal tumor

“…A subepithelial bulge with normal overlying mucosa in the region of the stomach may arise due to a number of causes including submucosal lesions (gastrointestinal stromal tumor, leiomyomas, neuroendocrine tumors, lipomas, granular cell tumors, duplication cysts, pancreatic rest) or from extrinsic lesions such as hepatic lesions, splenic lesions, pancreatic collections or lesions, or gall bladder. [8,9] A submucosal bulge with normal overlying mucosa has been rarely reported with tuberculosis. [6,7] Isolated gastric tuberculosis is very rare with antrum being the most common site of involvement, and its endoscopic appearances are variable with both ulcers and polypoidal lesions being described.…”

“…[3][4][5] A submucosal bulge with the normal overlying mucosa is usually due to submucosal tumors or vascular lesions and has been rarely reported with tuberculosis. [5][6][7][8] We present a 28-year-old female, who had gastric tuberculosis and the lesion on endoscopy mimicked a submucosal tumor.…”