4542 Endoscopic ultrasonography value in the diagnosis and follow up of the malt gastric lymphoma after helicobacter pylori treatment.

Abstract

Introduction. Gastric lymphomas represent the 3 to 10% of the gastric neoplasms. Endoscopic Ultrasonography (EUS) is today the gold standard to evaluate the gastric wall, allowing the reliable measurement of the wall thickness, tumor extension and peri gastric node involvement. These characteristics make this tool the first choice to follow up the response of patients with gastric lymphoma under treatment. The main objective of this study was to prospectively evaluate the utility of EUS in the follow up of patients with superficial involvement of low grade MALT gastric lymphoma (mucosa associated lymphoid tissue) under treatement for Helicobacter pylori. Methods.The study was conducted at the Clinica Reina Sofía a tertiary care center. The inclusion criteria were patients with histology and immuno histochemistry diagnosis of low grade MALT gastric lymphoma with superficial involvement (no deeper than submucosa layer and without node involvement). EUS was performed before and on the 3rd, 6th, 9th, 12th, and 18th month after antibiotic treatment with claritromicin, amoxacilin and lansoprazol for Helicobacter pylori eradication. The main outcome variable was defined as the measurement of the tumor involvement of the gastric wall (in millimeters, normal value of 3 mm) by EUS on the specified times. At the same time, biopsy samples were taken. Results.The study period of time was 18 months; during this time, 14 patients were included in the study. The median of the gastric mucosa before treatment was 7 mm (range 3 - 9 mm). Two patients did not respond to the treatment and remained with the same gastric mucosa thickness and positive biopsy for the neoplasm. There was a significant reduction of the gastric mucosa thickness after the sixth month of treatment in 12 patients (85.7%), with a median of 4 mm. The tumor was not evident at the biopsy specimen in this group of patients and the eradication of the Helicobacter pylori was demonstrated. There was a good correlation between the EUS evaluation and the histological findings for tumor evidence and for Helicobacter pylori infection. Conclusions: The results of the present study showed that EUS is a useful tool for the diagnosis and follow up of patients with low grade MALT gastric lymphoma with superficial involvement. There was a good correlation between H pylori eradication, gastric mucosa thickness reduction by EUS and histopathological findings. Introduction. Gastric lymphomas represent the 3 to 10% of the gastric neoplasms. Endoscopic Ultrasonography (EUS) is today the gold standard to evaluate the gastric wall, allowing the reliable measurement of the wall thickness, tumor extension and peri gastric node involvement. These characteristics make this tool the first choice to follow up the response of patients with gastric lymphoma under treatment. The main objective of this study was to prospectively evaluate the utility of EUS in the follow up of patients with superficial involvement of low grade MALT gastric lymphoma (mucosa associated lymphoid tissue) under treatement for Helicobacter pylori. Methods.The study was conducted at the Clinica Reina Sofía a tertiary care center. The inclusion criteria were patients with histology and immuno histochemistry diagnosis of low grade MALT gastric lymphoma with superficial involvement (no deeper than submucosa layer and without node involvement). EUS was performed before and on the 3rd, 6th, 9th, 12th, and 18th month after antibiotic treatment with claritromicin, amoxacilin and lansoprazol for Helicobacter pylori eradication. The main outcome variable was defined as the measurement of the tumor involvement of the gastric wall (in millimeters, normal value of 3 mm) by EUS on the specified times. At the same time, biopsy samples were taken. Results.The study period of time was 18 months; during this time, 14 patients were included in the study. The median of the gastric mucosa before treatment was 7 mm (range 3 - 9 mm). Two patients did not respond to the treatment and remained with the same gastric mucosa thickness and positive biopsy for the neoplasm. There was a significant reduction of the gastric mucosa thickness after the sixth month of treatment in 12 patients (85.7%), with a median of 4 mm. The tumor was not evident at the biopsy specimen in this group of patients and the eradication of the Helicobacter pylori was demonstrated. There was a good correlation between the EUS evaluation and the histological findings for tumor evidence and for Helicobacter pylori infection. Conclusions: The results of the present study showed that EUS is a useful tool for the diagnosis and follow up of patients with low grade MALT gastric lymphoma with superficial involvement. There was a good correlation between H pylori eradication, gastric mucosa thickness reduction by EUS and histopathological findings.