Colonic bowel wall thickening: Is there a need for endoscopic evaluation?

Troppmann, M; Lippert, Elisabeth; Hamer, Okka W.; Kirchner, Gabriele I.; Endlicher, Esther

doi:10.1007/s00384-011-1362-x

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…When the colon is inflated, the wall thickness is less than 3 mm [19]. In CT taken under optimal conditions, the thickness of the colonic wall is considered normal up to 3 mm and pathological above 5 mm [8]. Colonic redundancy with solid-liquid stool makes it difficult to measure wall thickness.…”

Section: Discussionmentioning

confidence: 99%

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Colonic Wall Thickening Reported in Abdominal CT: Does It Always Imply Malignancy?

Akbaş

Bakir

Dasiran

et al. 2019

Gastroenterology Research and Practice

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Aim/Background. Early diagnosis of patients with colon cancer is one of the most important parameters affecting the survival of patients. In this study, we aimed to examine the effect of the age, hemoglobin (Hb), albumin, neutrophil lymphocyte ratio (NLR), thrombocyte lymphocyte ratio (PLR), and mean platelet values (MPV) on the separation of benign and malignant diseases in patients with suspected colon wall thickness (CWT) observed in abdominal computed tomography (CT) examination. Method. The study included 116 patients between the ages of 18 and 95 who had CT examination where the colon wall could be evaluated and who also had colonoscopy. Patients suspected for CWT in CT with difficulties in differential diagnosis were divided into two groups according to colonoscopic-histopathological evaluations. Normal or benign pathological causes were included in the first group, while malignant causes constituted the second group. Whether the two groups differed in terms of CWT, Hb, age, albumin, NLR, PLR, and MPV values was investigated with descriptive statistics. Results. One hundred and sixteen patients (74 males, 42 females) with CT examinations and colonoscopic sampling were included in the study. After colonoscopic and histopathological evaluations, there were 64 cases in the first group and 52 in the second group. According to the results of the univariate analysis and multivariate logistic regression, CWT, Hb, NLR, and MPV were identified to be independent variables for determining colon cancer. Conclusion. A combined evaluation of Hb, NLR, and MPV values in patients with CWT in abdominal CT examination may contribute to the separation of benign and malignant pathologies.

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Section: Discussionmentioning

confidence: 99%

“…There is no consensus on the use of colonoscopy in patients with CWT based on CT results [5,6]. Some advocate colonoscopy for these patients [7,8] while some recommend colonoscopy only for the risky group [2,9]. The American Gastroenterology Association still does not accept CWT as an absolute colonoscopy indication [1].…”

Section: Introductionmentioning

confidence: 99%

Colonic Wall Thickening Reported in Abdominal CT: Does It Always Imply Malignancy?

Akbaş

Bakir

Dasiran

et al. 2019

Gastroenterology Research and Practice

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“…The bowel wall thickening could be a manifestation of underlying inflammatory, infectious, ischemic, or neoplastic pathology or may represent normal findings because of technical reasons, such as inadequate distension of the bowel. Previously, the significance of colonic wall thickness was evaluated by various studies, and most of the studies have concluded that patients with colonic wall thickness on CT should undergo colonoscopy and biopsy as a majority of these patients will have an underlying disease . This recommendation of endoscopy has been made because of the increased risk of neoplastic diseases in the colon.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, the significance of colonic wall thickness was evaluated by various studies, and most of the studies have concluded that patients with colonic wall thickness on CT should undergo colonoscopy and biopsy as a majority of these patients will have an underlying disease. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] This recommendation of endoscopy has been made because of the increased risk of neoplastic diseases in the colon. However, the significance of ileocecal wall thickening on CT has been infrequently evaluated.…”

Section: Discussionmentioning

confidence: 99%

Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country

et al. 2018

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Background and Aim Clinical significance of ileocecal thickening on computed tomography (CT) is uncertain. We conducted this prospective study to determine the clinical relevance of ileal and/or cecal thickening on CT. Methods All patients with ileocecal thickening on CT were prospectively evaluated with ileocolonoscopy, biopsy, and other relevant investigations. Results Fifty patients (29 males, mean age 36.8 ± 13.21 years) were studied. Thirty nine (78%) patients presented with abdominal pain. On CT, 46 (92%) had a thickened wall of terminal ileum, 25 (50%) cecum, and 21 (42%) of both cecum and ileum. The mean wall thickness of ileum and cecum on CT was 7.23 + 3.2 mm and 5.5 + 3.1 mm, respectively. Final diagnosis was tuberculosis in 24 (48%) patients, Crohn's disease (CD) in 10 (20%), and adenocarcinoma in 1 patient. Colonoscopy demonstrated abnormal findings in 41 patients (82% patients with mucosal ulcerations being most common ( n = 20 (40%). Of 15 (30%) patients with ileocecal bowel wall thickening, 4 (8%) patients had normal colonoscopy and histopathology (incidental ileocecal wall thickening), and in the remaining 11 patients, histopathology showed non‐specific findings and these patients were asymptomatic without any specific treatment on last follow up ranging from 3 to 24 months. Involvement of cecum with ileocecal junction, ascending colon involvement, peri‐ileocecal stranding, and long‐segment stricture was significantly more common in patients with underlying disease as compared to nondiseased patients ( P < 0.05). Conclusion A majority of patients with ileocecal wall thickening on CT have an underlying disease and should be further investigated by ileocolonoscopy and biopsy.

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“…There is conflicting evidence in the literature with many studies advocating for endoscopic evaluation in all cases due to high rates of pathology [12][13][14] while some studies in the literature suggest that only patients deemed at an increased risk need endoscopic evaluation [15]. In addition to this, some studies in the literature attempt to delineate benign from malignant causes of MT [16].…”

Section: Introductionmentioning

confidence: 99%

The Use of Clinical Parameters as Adjuncts to Endoscopic Evaluation of Mural Thickening on Conventional Computed Tomography in Diagnosing Malignancy

et al. 2021

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Background: Mural thickening (MT) on computed tomography (CT) poses a diagnostic dilemma in the absence of clear reporting guidelines. The aim of this study was to analyse CT reports, identifying patients in whom gastrointestinal wall MT was observed, and to correlate these reports with subsequent endoscopic evaluation. Methods: Patients with MT who had follow-up endoscopy were included in the study (n = 308). The cohort was subdivided into upper gastrointestinal mural thickening (UGIMT) & lower gastrointestinal mural thickening (LGIMT). Results: In total, 55.71% (n = 122) of colonoscopies and 61.8% (n = 55) of gastroscopies were found to be normal. Haemoglobin (HB) level in combination with MT was a predictor of neoplasia in both arms (p = 0.04 UGIMT cohort, p < 0.001 LGIMT cohort). In addition to this, age was a significant correlative parameter in both UGIMT and LGIMT cohorts (p = 0.003, p < 0.001 respectively). Dysphagia and weight loss were associated with UGI malignancies (38 and 63% respectively) and rectal bleeding was correlative in 20% of patients with LGI malignancies. Conclusion: HB, advancing age, and red flag symptoms are potentially useful adjuncts to MT in predicting upper and lower gastrointestinal malignancies. We propose the adoption of a streamlined pathway to delineate patients who should undergo endoscopic investigation following CT identification of MT.

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Colonic bowel wall thickening: Is there a need for endoscopic evaluation?

Cited by 10 publications

References 9 publications

Colonic Wall Thickening Reported in Abdominal CT: Does It Always Imply Malignancy?

Colonic Wall Thickening Reported in Abdominal CT: Does It Always Imply Malignancy?

Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country

The Use of Clinical Parameters as Adjuncts to Endoscopic Evaluation of Mural Thickening on Conventional Computed Tomography in Diagnosing Malignancy

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