Comparative Study Of The Endoscopic Ultrasonography In The Management Of Primary Gastric Lymphoma

Objection: To analyze the impact of endoscopic ultrasonography(EUS)on primary gastric lymphoma(PGL)from stage to follow-up and explore the value of EUS contributing to the effective management for PGL.Methods: We retrospectively reviewed 92 patients diagnosed as PGL by endoscopy with biopsy and systematic auxiliary examinations.In addition,EUS was carried out in 45 patients,and the function of EUS on management for PGL had been mainly analyzed.Results: Four macroscopic patterns were presented under endoscopy: 57(62.0%)ulcerations,21(22.8%)protruding masses,11(12.0%)superficial lesions and 3(3.2%)diffuse infiltrations.Diffuse large B-cell lymphoma(DLBCL)was more likely to feature with ulceration or protruding mass,while for mucosa-associated lymphoid tissue(MALT)lymphoma,ulceration and superficial lesion were more common.According to the EUS examination of 45 patients,7(15.6%)lymphomas limited to the gastric mucosa,12(26.7%)limited to submucosa,11(24.4%)invaded to the muscularis propria,8(17.8%)invaded to the serosa,7(15.6%)were beyond serosa,and13(28.9%)had perigastric lymph node involvement.There were 28early-stage(T1-3N0-1M0)individuals based on TNM stage,and half(14/28)of them were treated with H.pylori eradication alone.In a result,we found anti-H.pylori therapy was extremely successful for T1N0 stage patients(n=10).The rest four patients with tumor invasion beyond submucosa(> T1sm)were unresponsive to treatment.In the follow-up setting,20 out of the 28 patients received endoscopy and EUS examinations in parallel at least three times and 82 endosonographies had been obtained.The concordance of outcome between the two examinations was 67.1%.Actually,It took a prolonged time to reach endosonograpic remission compare to histological remission in nine patients(11.89 vs 4.89 months,P=0.001).There were five patients appearing persistent endosonographic abnormalities but along with negative endoscopic findings,three of them maintained disease-free survival after histological remssion,while the rest two patients experienced relapse eventually.Conclusions: To date,endoscopy with biopsy is a predominant diagnostic tool,meanwhile EUS providing the information for stage and prognostic analysis is becoming another promising procedure.The increased awareness of the value of EUS techniques contributes to effective management for primary gastric lymphoma.