Clinical relevance of endoscopically identified extrinsic compression of the oesophagus and stomach.
endoscopy
extrinsic compression
malignancy
pancreatic cancer
weight loss
Journal
BMJ open gastroenterology
ISSN: 2054-4774
Titre abrégé: BMJ Open Gastroenterol
Pays: England
ID NLM: 101660690
Informations de publication
Date de publication:
2019
2019
Historique:
received:
25
04
2019
revised:
18
06
2019
accepted:
18
06
2019
entrez:
16
8
2019
pubmed:
16
8
2019
medline:
16
8
2019
Statut:
epublish
Résumé
Various degree of extrinsic compression of the oesophagus and stomach are experienced during upper endoscopy. However, its utility in clinical practice has not been studied. Electronic chart review of all upper gastrointestinal endoscopies done at our hospital between 2005 and 2016 was performed. A total of 79 patients with documented extrinsic compression on upper gastrointestinal procedure report who had a preceding or subsequent abdomen/chest CT imaging performed within 6 months were included. 30 (38%) out of 79 patients had abnormal finding on CT scan. 14 (47%) out of 30 patients had an associated malignant lesion, whereas remaining had a benign lesion. Overall, patients with associated gastrointestinal symptoms (60% vs 22%, p=0.001) or history of weight loss (50% vs 16%, p=0.001) had increased odds of having an abnormal finding on CT scan compared with the patients who lacked such symptoms. Pancreatic cancer was the most commonly diagnosed malignancy. On subgroup analysis of patients with extrinsic compression and malignant lesion on imaging study, the likelihood of a malignancy was higher in blacks as compared with Hispanics (71%:29% vs 39%:61%, p=0.031), and with presence of gastrointestinal symptoms (64% vs 22%, p=0.003), presence of weight loss (64% vs 16%, p=0.0001) and hypoalbuminaemia (p=0.001). Finding an extrinsic compression of the oesophagus and stomach on an upper endoscopy may suggest malignancy, and hence should prompt further work-up. Posterior wall gastric body compression may signal the presence of pancreatic cancer.
Sections du résumé
BACKGROUND
BACKGROUND
Various degree of extrinsic compression of the oesophagus and stomach are experienced during upper endoscopy. However, its utility in clinical practice has not been studied.
METHODS
METHODS
Electronic chart review of all upper gastrointestinal endoscopies done at our hospital between 2005 and 2016 was performed. A total of 79 patients with documented extrinsic compression on upper gastrointestinal procedure report who had a preceding or subsequent abdomen/chest CT imaging performed within 6 months were included.
RESULTS
RESULTS
30 (38%) out of 79 patients had abnormal finding on CT scan. 14 (47%) out of 30 patients had an associated malignant lesion, whereas remaining had a benign lesion. Overall, patients with associated gastrointestinal symptoms (60% vs 22%, p=0.001) or history of weight loss (50% vs 16%, p=0.001) had increased odds of having an abnormal finding on CT scan compared with the patients who lacked such symptoms. Pancreatic cancer was the most commonly diagnosed malignancy. On subgroup analysis of patients with extrinsic compression and malignant lesion on imaging study, the likelihood of a malignancy was higher in blacks as compared with Hispanics (71%:29% vs 39%:61%, p=0.031), and with presence of gastrointestinal symptoms (64% vs 22%, p=0.003), presence of weight loss (64% vs 16%, p=0.0001) and hypoalbuminaemia (p=0.001).
CONCLUSION
CONCLUSIONS
Finding an extrinsic compression of the oesophagus and stomach on an upper endoscopy may suggest malignancy, and hence should prompt further work-up. Posterior wall gastric body compression may signal the presence of pancreatic cancer.
Identifiants
pubmed: 31413857
doi: 10.1136/bmjgast-2019-000310
pii: bmjgast-2019-000310
pmc: PMC6673764
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e000310Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Scand J Gastroenterol. 2002 Jul;37(7):856-62
pubmed: 12190103
Surg Radiol Anat. 2012 Mar;34(2):171-8
pubmed: 22057798
Gastroenterology. 2012 Nov;143(5):1179-1187.e3
pubmed: 22885331
Internist (Berl). 2014 Sep;55(9):1026-30, 1032-3, 1036-8
pubmed: 25070611
Fam Pract. 2016 Oct;33(5):449-52
pubmed: 27343860
PLoS One. 2017 Apr 7;12(4):e0175125
pubmed: 28388637