Brief Article
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World J Gastrointest Endosc. Mar 16, 2013; 5(3): 111-116
Published online Mar 16, 2013. doi: 10.4253/wjge.v5.i3.111
Diagnosis of the jejunoileal lymphoma by double-balloon endoscopy
Takashi Ibuka, Hiroshi Araki, Tomohiko Sugiyama, Takayuki Nakanishi, Fumito Onogi, Masahito Shimizu, Takeshi Hara, Tsuyoshi Takami, Hisashi Tsurumi, Hisataka Moriwaki
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
Hiroshi Araki, Department of Gastroenterology, Gifu University School of Medicine, Gifu 501-1194, Japan
Tsuyoshi Takami, Department of Immunopathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
Author contributions: Ibuka T, Araki H, Sugiyama T, Nakanishi T, Onogi F and Shimizu M carried out double-balloon endoscopy; Hara T and Tsurumi H clinically managed the lymphoma patients; Takami T made histopathological diagnosis of lymphoma; Ibuka T, Araki H and Moriwaki H designed the study, analyzed the data and prepared the manuscript.
Correspondence to: Hiroshi Araki, MD, Department of Gastroenterology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan. araara@gifu-u.ac.jp
Telephone: +81-58-2306308 Fax: +81-58-2306310
Received: April 8, 2012
Revised: August 14, 2012
Accepted: January 23, 2013
Published online: March 16, 2013
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Double-balloon endoscopy, Non-Hodgkin’s lymphoma, Jejunoileum, Fluorodeoxyglucose positron emission tomography, Follicular lymphoma