Abstracts: ESOPHAGUS
Incidental Esophageal Wall Thickening on Computed Tomography: To Scope or not to Scope?
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Purpose: The widespread use of computed tomography (CT) in the evaluation of patients with various medical complaints has given rise to reports of incidental gastrointestinal wall thickening. The clinical significance of incidental esophageal wall thickening (IEWT) remains uncertain.
Methods: In order to determine the endoscopic significance of IEWT, we reviewed 1232 patients who were found to have esophageal wall thickening on a CT. We excluded 336 patients who had symptoms suggestive of esophageal pathology or known esophageal diseases. We reviewed 896 patients from which 119 underwent endoscopic evaluation for IEWT.
Results: The mean age of the patients was 63 years with no significant difference in gender distribution. 96 patients were found to have IEWT localized to the lower esophagus, 3 to the upper, and 1 to the mid-esophagus. 13 patients had diffuse IEWT. All the patients who had upper IEWT had a normal endoscopic evaluation. There was 1 case of esophageal cancer which occurred in the only patient who had IEWT localized to the mid-esophagus. From the 96 patients who had lower IEWT, 41 had a normal endoscopic evaluation (42.7%) and 55 were found to have an abnormality in the esophagus during their esophagogastroduodenoscopy (EGD) (47.3%). There was no statistical difference in age, gender, race or prior history of heart failure, liver cirrhosis or hypoalbuminemia between both groups. From the patients who had an abnormal EGD, the most common finding was esophagitis (43.6%), followed by hiatal hernia (HH) (36.3%). Less common findings included esophageal strictures (14.5%), esophageal varices (12.7%), candidiasis of the esophagus (7.2%), Barrett's (5.4%), and esophageal diverticula (3.6%). From the patients with lower IEWT, 59 were found to have a HH on CT. EGD confirmed the presence of a HH in sixteen of these patients (27.1%), whereas four (10.8%) patients were found to have a HH without mention of this finding on CT. There was no significant difference in the endoscopic finding of HH in both groups (p=0.072). There was no significant difference between patients with or without a HH on CT who had a normal EGD (40.7% vs. 46.9%, p=0.67). Nine from the 12 patients with diffuse esophageal wall thickening had an abnormal EGD and the most common finding was esophagitis in 4 of them.
Conclusion: We conclude that IEWT is an uncommon finding but may represent a significant esophageal process. We strongly recommend endoscopic evaluation in patients with localized mid-esophagus IEWT and diffuse esophageal wall thickening. Patients with lower IEWT may benefit for endoscopic evaluation, unlike patients with localized upper IEWT.