title: Endoscopic ultrasonography for the initial staging and follow-up in patients with low-grade gastric lymphoma of mucosa-associated lymphoid tissue treated medically.
abstract: BACKGROUND
  Endoscopic ultrasonography is an appropriate procedure to assess the depth of tumoral infiltration in primary gastric lymphoma. The aims of the present study were to characterize the endoscopic ultrasonographic aspects of low-grade gastric lymphoma of mucosa-associated lymphoid tissue and to determine the value of this procedure in medical treatment assessment.
  
  
  METHODS
  Between 1991 and 1996, 15 patients with low-grade gastric lymphoma of mucosa-associated lymphoid tissue were treated with oral cyclophosphamide and/or anti-Helicobacter pylori treatment. Endoscopic ultrasonography was carried out at the time of the diagnosis in all patients, 8 of whom (4 in complete remission and 4 with a stable or progressive disease) had at least one endoscopic ultrasonography examination within the treatment period (median follow-up 17 months).
  
  
  RESULTS
  The initial procedure showed an increased gastric wall thickness from 6 to 12 mm in 8 patients, equal to 5 mm in 5 patients, and normal in 2 patients. The thickening was predominantly of the mucosa alone and/or the submucosa but never extended beyond the muscularis propria. No lymph node was found. Gastric wall thickness returned to normal in the 4 patients in complete remission and remained thick in 3 of the 4 patients with a stable or progressive disease. Of these 3 patients, at least one set of biopsy samples, carried out during follow-up, showed the absence of lymphoma, but histology performed subsequently found evidence of disease.
  
  
  CONCLUSIONS
  Endoscopic ultrasonography differentiates superficial from infiltrative types of gastric lymphoma of mucosa-associated lymphoid tissue, which may have a prognostic significance and confirms remission or persistence of the disease with medical treatment during follow-up. When the gastric wall remains thick, even if histology is negative, repeated biopsies should be performed to detect evolving disease or relapse.
authors.affiliation: Service de Gastroentérologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: M
authors.initials: M
authors.lastname: Lévy
authors.forename: P
authors.initials: P
authors.lastname: Hammel
authors.forename: D
authors.initials: D
authors.lastname: Lamarque
authors.forename: O
authors.initials: O
authors.lastname: Marty
authors.forename: M T
authors.initials: MT
authors.lastname: Chaumette
authors.forename: C
authors.initials: C
authors.lastname: Haioun
authors.forename: M
authors.initials: M
authors.lastname: Blazquez
authors.forename: J C
authors.initials: JC
authors.lastname: Delchier
mesh_terms: D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D009853:Omeprazole / Q000008:administration & dosage; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D018906:Antineoplastic Agents, Alkylating; D008795:Metronidazole; D000658:Amoxicillin; D003520:Cyclophosphamide; D017291:Clarithromycin; D009853:Omeprazole