title: Diagnosis of the jejunoileal lymphoma by double-balloon endoscopy.
abstract: OBJECTIVE
  To investigate the feasibility of double-balloon endoscopy (DBE) to detect jejunoileal lymphoma, compared with fluorodeoxyglucose positron emission tomography (FDG-PET).
  
  
  METHODS
  Between March 2004 and January 2011, we histologically confirmed involvement of malignant lymphoma of the jejunoileum in 31 patients by DBE and biopsy. In 20 patients of them, we performed with FDG-PET. We retrospectively reviewed the records of these 20 patients. Their median age was 64 years (range 50-81). In the 20 patients, the pathological diagnosis of underlying non-Hodgkin's lymphoma (NHL) comprised follicular lymphoma (FL, n = 12), diffuse large B cell lymphoma (DLBCL, n = 4), mantle cell lymphoma (MCL, n = 2), enteropathy associated T cell lymphoma (ETL, n = 1) and anaplastic large cell lymphoma (ALCL, n = 1).
  
  
  RESULTS
  Ten cases showed accumulation by FDG-PET (50%). FDG-PET was positive in 3 of 12 FL cases (25%) while in 7 of 8 non-FL cases (88%, P < 0.05). Intestinal FL showed a significantly lower rate of positive FDG-PET, in comparison with other types of lymphoma. Cases with endoscopically elevated lesions (n = 10) showed positive FDG-PET in 2 (20%), but those with other type NHL did in 8 of 10 (80%, P < 0.05). When the cases having elevated type was compared with those not having elevated type lesion, the number of cases that showed accumulation of FDG was significantly smaller in the former than in the latter.
  
  
  CONCLUSIONS
  In a significant proportion, small intestinal involvement cannot be pointed out by FDG-PET. Especially, FL is difficult to evaluate by FDG-PET but essentially requires DBE.
authors.affiliation: Takashi Ibuka, Hiroshi Araki, Tomohiko Sugiyama, Takayuki Nakanishi, Fumito Onogi, Masahito Shimizu, Takeshi Hara, Hisashi Tsurumi, Hisataka Moriwaki, First Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ibuka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Araki
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Fumito
authors.initials: F
authors.lastname: Onogi
authors.forename: Masahito
authors.initials: M
authors.lastname: Shimizu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hara
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takami
authors.forename: Hisashi
authors.initials: H
authors.lastname: Tsurumi
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
keywords: Double-balloon endoscopy; Fluorodeoxyglucose positron emission tomography; Follicular lymphoma; Jejunoileum; Non-Hodgkin’s lymphoma