Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2017; 23(26): 4788-4795
Published online Jul 14, 2017. doi: 10.3748/wjg.v23.i26.4788
Endoscopy is of low yield in the identification of gastrointestinal neoplasia in patients with dermatomyositis: A cross-sectional study
Trilokesh D Kidambi, Gabriela Schmajuk, Andrew J Gross, James W Ostroff, Jonathan P Terdiman, Jeffrey K Lee
Trilokesh D Kidambi, James W Ostroff, Jonathan P Terdiman, Jeffrey K Lee, Division of Gastroenterology, University of California, San Francisco, CA 94115, United States
Gabriela Schmajuk, Andrew J Gross, Division of Rheumatology, University of California, San Francisco, San Francisco, CA 94115, United States
Gabriela Schmajuk, Division of Rheumatology, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94115, United States
Author contributions: Kidambi TD study concept and design, data acquisition, analysis and interpretation, drafting of manuscript, critical revision of manuscript; He has approved the final draft of the manuscript; Schmajuk G study concept, data acquisition, critical revision of manuscript. She has approved the final draft of the manuscript; Gross AJ study concept, critical revision of manuscript. He has approved the final draft of the manuscript; Terdiman JP study concept, critical revision of manuscript. He has approved the final draft of the manuscript; Lee JK study concept and design, data interpretation, drafting of manuscript, critical revision of manuscript, study supervision. He has approved the final draft of the manuscript; all authors contributed to this manuscript.
Supported by National Cancer Institute, No. K07CA212057; and American Gastroenterological Association.
Institutional review board statement: The study was approved by the University of California, San Francisco Institutional Review Board.
Informed consent statement: Waived by institutional review board given retrospective nature of the study.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jeffrey K Lee, MD, MAS, Division of Gastroenterology, University of California, 1701 Divisadero, San Francisco, CA 94115, United States. jeff.lee@ucsf.edu
Telephone: +1-415-5024444
Received: March 23, 2017
Peer-review started: March 28, 2017
First decision: May 10, 2017
Revised: May 16, 2017
Accepted: June 9, 2017
Article in press: June 9, 2017
Published online: July 14, 2017
Processing time: 111 Days and 5.7 Hours
Abstract
AIM

To determine the prevalence of gastrointestinal neoplasia among dermatomyositis patients who underwent an esophagogastroduodenoscopy and/or colonoscopy.

METHODS

A cross-sectional study examining the results of upper endoscopy and colonoscopy in adults with dermatomyositis at an urban, university hospital over a ten year period was performed. Chart review was performed to confirm the diagnosis of dermatomyositis. Findings on endoscopy were collected and statistical analyses stratified by age and presence of symptoms were performed.

RESULTS

Among 373 adult patients identified through a code based search strategy, only 163 patients had dermatomyositis confirmed by chart review. Of the 47 patients who underwent upper endoscopy, two cases of Barrett’s esophagus without dysplasia were identified and there were no cases of malignancy. Of the 67 patients who underwent colonoscopy, no cases of malignancy were identified and an adenoma was identified in 15% of cases. No significant differences were identified in the yield of endoscopy when stratified by age or presence of symptoms.

CONCLUSION

The yield of endoscopy is low in patients with dermatomyositis and is likely similar to the general population; we identified no cases of malignancy. A code based search strategy is inaccurate for the diagnosis of dermatomyositis, calling into question the results of prior population-based studies. Larger studies with rigorously validated search strategies are necessary to understand the risk of gastrointestinal malignancy in patients with dermatomyositis.

Keywords: Endoscopy; Dermatomyositis; Colon cancer; Screening

Core tip: Dermatomyositis is associated with an increased risk of gastrointestinal (GI) malignancies based on large-population based studies. These prior studies utilized code-based search strategies and did not perform individual chart review. The yield of endoscopy in this patient population is not known. In this study, endoscopy identified no cases of malignancy and was of low yield, likely similar to the general population, in the identification of pre-malignant findings. Code-based searched strategies were inaccurate in the identification of dermatomyositis, calling into question the results of prior population-based studies. The association between increased GI malignancy and dermatomyositis may be lower than previously reported.