PTU-070 Non-specific upper GI mural thickening on CT – is it just from peristalsis?

Introduction BSG published guidance on the indications for diagnostic endoscopy in April 2013, including abnormal or suspicious findings on CT imaging. Non-specific upper GI mural thickening on CT is a common abnormal finding raising the suspicion of upper GI malignancy. The correlation between CT mural thickening in the upper GI tract and endoscopic diagnosis of malignancy is not clearly known. Methods A retrospective single centre study of patients referred for gastroscopy with the indication of ‘abnormal imaging’ (n=147) was performed. Data was collected using the endoscopy software audit tool over a 3-year period (2016 to 2018). Patients with a CT reported finding of ‘mural thickening’ were included for analysis (n=59). Statistics were performed using Welch’s t-test. Results 59 patients underwent gastroscopy for CT reported mural thickening: oesophageal 20 (34%), GOJ 9 (15%), gastric 23 (39%), pyloric 4 (7%), duodenal 5 (8%) and jejunal 1 (2%). Median time from CT to endoscopy was 21 days (IQR 12–54). Median age was 77 (IQR 62–83). Initial indication for CT scan included: weight loss 16 (27%), abdominal pain 14 (24%), possible malignancy 6 (10%) and dysphagia 3 (5%). 11 (19%) patients had a normal gastroscopy, 24 (41%) showed inflammatory changes (oesophagitis or gastritis), 20 (34%) had evidence of a hiatus hernia, and 5 (8%) had benign polyps. 5 (9%) had a histological diagnosis of gastric adenocarcinoma, 4 (7%) of Barrett’s oesophagus and 1 (2%) of squamous dysplasia. The 5 patients with adenocarcinoma could not be reliably identified by indication for imaging (2 for abdominal pain, 1 for weight loss, and 2 for non GI or systemic related symptoms). The mean haemoglobin for the patients with malignancy was 104 g/L vs 125 g/L for the overall study group (p=0.13, NS). The mean albumin for the patients with malignancy was 37.6 g/L vs 38.4 g/L for the overall study group (p=0.81, NS). Conclusions Upper GI mural thickening on CT cannot be dismissed. Despite oesophagitis, gastritis and hiatus hernia making up most endoscopic diagnoses (75%), it correlated with malignancy, dysplasia or metaplasia in 10/59 (17%) patients in this study. Patients with malignancy could not be accurately differentiated by indication for imaging or by biochemical markers. We conclude that there is good concordance in pathology detection at gastroscopy following findings of thickening on CT scan. We recommend gastroscopy is performed in every case when this abnormality is detected incidentally.