Association of Abnormal CT Scan Findings in the Upper GI Tract with an Esophagogastroduodenoscopy

Abstract

Purpose: Patients with abnormal CT scan findings in the upper GI tract are often referred for further evaluation with an upper endoscopy. Currently there are no guidelines to classify what type of CT scan findings need to be followed with an endoscopy. A literature review shows some studies have assessed the role of gastrointestinal endoscopy in this situation with different conclusions. The goal of our study is to associate the CT scan findings in the upper GI tract with upper GI endoscopy findings. Methods: Retrospective chart review consisted of adult patients who had an upper endoscopy performed because of an abnormal CT scan between September 1, 2001-April 25, 2011. Abnormal CT findings were correlated with endoscopic findings. Results: 179 subjects had abnormal findings in the upper GI tract on CT scan and were investigated with an upper endoscopy. Mean age of our subjects was 60 years (17-107), and 42% were female. The CT scan findings correlated with abnormal upper endoscopy in 73 /179 subjects. 61 patients had wall thickening on CT scan, 4 patients had esophageal mass, 7 patients had a gastric mass seen on CT scan, and 1 patient had a duodenal mass. Of the 61 patients with wall thickenings, 26 (42%) had esophageal wall thickening, 22 (37%) in stomach wall, and 12 (20%) in duodenum wall. Table 1 shows upper endoscopy findings of patients with esophageal wall thickening seen on CT scan. One patient had an esophageal tumor and the biopsy showed invasive adenocarcinoma. Table 2 shows EGD findings of patients with stomach wall thickening seen on CT scan. Of the 22 patients with stomach wall thickening seen on CT, 7 patients had gastric ulcers on EGD, 2 were H. pylori positive. The biopsy of 2 patients with submucosal gastric tumors showed chronic inflammation. Of the 12 patients with duodenal wall thickening; 5 patients had duodenitis, 5 patients had duodenal ulcers; biopsy of one of the ulcers showed poorly differentiated adenocarcinoma of the duodenum. Of the 7 patients with gastric mass seen on CT scan, upper GI endoscopy revealed 3 patients with gastritis, 2 patients had a gastric mass and the biopsies showed malignant neoplasms. EGD of 2 patients showed a gastric diverticulum and multiple small papules. The patient with duodenal mass on CT scan had a mass on EGD. The biopsy showed poorly differentiated adenocarcinoma.Table 1: Upper endoscopy findings of patients with esophageal wall thickening seen on CT scanTable 2: Upper endoscopy findings of patients with stomach wall thickening seen on CT scanConclusion: Majority of the upper GI findings seen on CT scan did have abnormal endoscopy. In our study abnormal CT scan was found to be associated with malignancy in 5 patients. Therefore, all abnormal CT scans should be pursued with an upper endoscopy if no clear etiology is present.