Is There a Role for Capsule Endoscopy in the Staging Work-up of Patients with Gastric Marginal Zone B-cell Lymphoma of MALT?

Abstract

Introduction: In earlier studies, involvement of the small intestine was reported in patients with gastrointestinal lymphoma. Prospective data on the involvement of the small intestine in patients suffering from gastric extranodal MZBCL of MALT do not exist so far. In this study, we investigated the frequency of the involvement of the small intestine and the role of capsule endoscopy in patients with gastrointestinal extranodal MZBCL of MALT and of follicular lymphoma.

Patients and Methods: 40 consecutive patients with gastrointestinal extranodal MZBCL of MALT (26 men, 14 women, aged 27 − 80 years), and 7 patients with known follicular lymphoma of the small intestine (5 men, 2 women, aged 34 − 63 years) underwent capsule endoscopy.

Results: Involvement of the small intestine was identified by capsule endoscopy in all 7 patients with known follicular lymphoma of the small intestine. In 6 of 40 patients with gastric extranodal MZBCL of MALT abnormal findings could be observed, three of these findings indicative for lymphoma involvement of the small intestine. However, in each of these 3 cases, intestinal involvement had been already diagnosed by conventional GI endoscopy before capsule endoscopy.

Conclusions: Capsule endoscopy is able to detect involvement of the small intestine in patients with gastrointestinal lymphoma. However, involvement of the small intestine seems to be rare in patients with gastric extranodal MZBCL of MALT. In summary, routine diagnostic work-up of the small intestine, e. g. by capsule endoscopy seems unnecessary because of the rare involvement of the small intestine and an excellent long-term outcome irrespective of a possible intestinal manifestation.

Zusammenfassung

Einleitung: Frühere Studien haben auf die Beteiligung des Dünndarms bei Patienten mit gastrointestinalen Lymphomerkrankungen hingewiesen. Prospektive Daten zur Dünndarmbeteiligung bei Patienten mit gastralem extranodalen Marginalzonenlymphom (MZBCL) vom MALT-Typ stehen bislang nicht zur Verfügung. In dieser Studie haben wir die Häufigkeit einer Dünndarmbeteiligung und den Stellenwert der Kapselendoskopie bei Patienten mit einem gastralen extranodalen MZBCL vom MALT-Typ sowie bei Patienten mit gastrointestinalem follikulärem Lymphom untersucht.

Patienten und Methoden: 40 konsekutive Patienten mit gastrointestinalem extranodalen MZBCL vom MALT-Typ (26 Männer, 14 Frauen, Alter 27 – 80 Jahre), und 7 Patienten mit vorbekanntem follikulären Lymphom des Dünndarms (5 Männer, 2 Frauen, Alter 34 – 63 Jahre) wurden mittels Kapselendoskopie untersucht.

Ergebnisse: Eine Beteiligung des Dünndarms wurde mittels Kapselendoskopie bei allen 7 Patienten mit vorbekanntem follikulären Lymphom des Dünndarms identifiziert. Bei 6 von 40 Patienten mit gastralem extranodalen MZBCL vom MALT-Typ zeigte die Kapselendoskopie Auffälligkeiten im Dünndarm, davon bei 3 Patienten im Sinne einer Lymphombeteiligung des Dünndarms. Allerdings war in allen 3 Fällen die Dünndarmbeteiligung bereits durch eine konventionelle Endoskopie des Gastrointestinaltraktes vor Durchführung der Kapselendoskopie diagnostiziert worden.

Schlussfolgerung: Mittels Kapselendoskopie kann eine Lymphombeteiligung des Dünndarms bei Patienten identifiziert werden. Bei Patienten mit gastralem extranodalen MZBCL vom MALT-Typ scheint eine Dünndarmbeteilung selten aufzutreten. Zusammenfassend erscheint bei diesen Patienten eine routinehafte Dünndarmdiagnostik z. B. mittels Kapselendoskopie aufgrund der selten auftretenden Dünndarmbeteiligung und des exzellenten Langzeitverlaufs unabhängig vom Dünndarmbefall nicht erforderlich.

Key words

MALT-Lymphoma - capsule endoscopy - small intestine

Schlüsselwörter

MALT-Lymphom - Kapselendoskopie - Dünndarm

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