Endoscopic Significance of Incidental Upper Gastrointestinal Wall Thickness Detected on Computed Tomography Scans

Abstract

Background Incidental upper gastrointestinal wall thickness (GIWT) is a nonspecific finding often observed on computed tomography (CT) scans performed to investigate patients admitted with various symptoms both gastrointestinal (GI) and non-GI. Its clinical significance is uncertain, and patients often undergo endoscopic evaluation under an urgent cancer pathway to exclude malignancy. We aimed to conduct this study to determine how well the CT findings correlated endoscopically. Methods A retrospective data collection was performed for patients who were referred to the endoscopy department between July 2021 and July 2024 for evaluation of GIWT over a period of four years. We analyzed age, gender, reason for initial CT, endoscopic findings, histology findings, and evidence of cancer. Results Our final cohort included 50 patients who underwent endoscopic and subsequent histological examination following abnormal CT findings. The mean age of the included cohort was 71. Thirty-one were males and 19 patients were females. Ninety percent had esophageal wall thickness while 10% had gastric wall thickness. Twenty-six percent of patients had red flag symptoms such as weight loss and iron deficiency anemia as an indication for undergoing CT scans. About 8% of the patients were confirmed to have malignancy on endoscopy of which 6% had red flag symptoms such as weight loss and iron deficiency anemia. Seventy-eight percent of the cohort had gastroscopy within two to four weeks, 10% in four to 12 weeks and 12% after 12 weeks. Conclusion Our results illustrate that a majority of people with incidental GIWT had benign pathologies whereas a small number of patients had malignancy. It is worth noting that malignancy was more common among patients who had red flag symptoms, and therefore urgent endoscopy assessment under the urgent cancer pathway is recommended in these patients. On the contrary, the risk is noted to be low in patients with no red flag symptoms, therefore we recommend assessing such patients individually for the need for endoscopic evaluation based on detailed history and examination. We think further multicenter large studies are required in this area of research and develop standard protocols in relation to investigating incidental upper GIWT with endoscopy.