Gastrointestinal manifestation of systemic sclerosis—thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign

Abstract

Objective. Gastrointestinal (GI) tract involvement has been observed in the majority of patients with SSc. This has been attributed to an accumulation of extracellular matrix within the GI walls. We visualized the walls of the oesophagus, stomach and duodenum with its layers and measured the thickness in SSc patients and control patients utilizing endoscopic ultrasound (EUS).Methods. Twenty-five SSc patients and 25 controls were evaluated. In addition to analysis of clinical symptoms, endoscopy and EUS (20-MHz miniprobe) were performed. The thickness of the complete wall was measured, and the mucosa, submucosa and muscularis were evaluated separately. Conclusions. The EUS revealed a significant thickening of the walls of the upper GI tract in SSc patients. Predominantly, the submucosa and muscularis are enlarged. These results strengthen the hypothesis that increased matrix deposition is an important aspect in the pathogenesis of GI involvement in SSc.

The association between systemic sclerosis disease manifestations and esophageal high‐resolution manometry parameters

“…Dermal skin thickness, which is caused by increased collagen deposition, is thought to correlate with more severe internal organ involvement, morbidity, and mortality . A study utilizing endoscopic ultrasound identified thickened (compared with normal controls) esophageal walls, mainly in the submucosa and muscularis, in 14 patients with dcSSc and 11 lcSSc, which also correlated with the presence of dysphagia . Prior studies report variable associations between esophageal dysfunction and esophageal symptoms in patients with SSc, including reports of asymptomatic individuals with severe esophageal disease .…”

Endoluminal ultrasound applicators for MR‐guided thermal ablation of pancreatic tumors: Preliminary design and evaluation in a porcine pancreas model

“…1), which is intimately attached to the head and would facilitate luminal sparing due to the thinner thickness of the duodenal wall (2 mm distended) as compared to the stomach wall (3-5 mm) in humans. [33][34][35] In the porcine model, the head of the pancreas (the duodenal lobe) is the smallest volumetric portion of the pancreas 36 and is separated from the medial duodenum by mesentery, leaving potential gaps between the two organs. 37 Further, the pyloric region that connects the stomach and duodenum contains a mucosal protuberance called the torus pyloricus, which results in much more constriction in the porcine model than in humans, impeding endoluminal access.…”

Thermal therapy of pancreatic tumours using endoluminal ultrasound: Parametric and patient-specific modelling

“…Localized cooling effects of major blood vessels were modeled using heat flux boundary conditions at the inner surface of the blood vessels, with an ambient blood temperature of 37 °C, and the heat transfer coefficient h value was calculated using the method detailed by Haemmerich et al, with vasculature parameters obtained from literature [55–60]. The duodenal and stomach walls were modeled as 2 mm and 3 mm thick, respectively [53,61,62]. Feedback control over the maximum tumor temperature was applied for the ablation simulations and transient temperature solutions were obtained.…”