SP5.1.13 Upper gastrointestinal (UGI) mural thickening on Computed Tomography (CT) and its significance in the multi-disciplinary team (MDT) pathway

Abstract

Abstract Aims Patients are frequently referred to the UGI MDT based on CT reported thickening of either the oesophagus, stomach or duodenum. We have sought to illustrate the efficacy of CT within the UGI cancer referral pathway. Method A retrospective analysis was carried out on patients referred to the UGI MDT at a University Teaching Hospital over a 22-month period. Patients referred with CT evidence of UGI tract thickening prior to endoscopy were included. CT findings were correlated with symptomatology, subsequent endoscopy and histology findings. Results 442 patients were referred to the UGI MDT between April 2014 and February 2016. 125 were referred for CT thickening alone (67 (53.2%) oesophageal, 49 (39.2%) gastric, 9 (7.2%) duodenal). 49 (39.2%) patients were subsequently diagnosed with UGI cancer, 57 (45.6%) had evidence of benign disease and 18 (14.4%) patients had no abnormality evident on endoscopy. CT thickening of 15mm and above was significantly more likely be malignant versus thickening less than 15mm [42/87 (48.3%) vs 7/38 (18.4%); p < 0.05]. Patients with thickening in the presence of a hiatus hernia were significantly less likely to have an associated cancer vs those without [3/26 (13%) vs 20/42 (51.1%); p < 0.05]. Conclusion We conclude that patients should not be referred for MDT opinion on CT evidence of UGI thickening alone. All patients should have an endoscopy prior to referral, particularly those with a hiatal hernia on CT. A high index of suspicion for malignancy should be adopted in patients with thickening greater than 15mm on imaging.