GASTRODUODENAL INVOLVEMENT IN STAGING OF NODAL NON-HODGKIN LYMPHOMAS - A CLINICAL AND ENDOSCOPIC PROSPECTIVE-STUDY OF 235 PATIENTS

Objectives: The gastrointestinal tract is often the site of involvemen t of non-Hodgkin lymphomas (NHL). The aim of this endoscopic prospecti ve study was to verify the prevalence of the gastroduodenal involvemen t in patients in staging for NHL and to assess its impact on the choic e of therapeutic strategics. Methods: Two hundred and thirty-five cons ecutive patients were included in the study. Upper gastrointestinal en doscopy was performed, and biopsy samples were taken on every mucosal lesion and on macroscopically illness-free duodenal and gastric mucosa . The samples were submitted to histological examination, and the clin ical stage of NHL was reevaluated. Results: Sixty-one of the 235 patie nts exhibited histological involvement of gastric (40), duodenal (7), or both (14) mucosae. Endoscopic lesions were recorded in 51 patients, but the involved mucosa appeared macroscopically normal in 10 patient s (16.3%), In 13 patients, the gastroduodenal involvement modified the clinical stage from I and II to III, indicating a different therapeut ic approach. No difference was detected in the frequency of gastrointe stinal involvement among the high, intermediate, and low grades of lym phoma malignancies. Thirty-five positive patients underwent a further endoscopic examination after the chemotherapy treatment. Although clin ical remission was expected in all cases, 42.8% of them subsequently e xhibited NHL. Conclusions: Upper digestive endoscopy plus biopsy sampl ing plays a necessary diagnostic role, not only when major clinical si gns (hemorrhage) are present, but also in earlier stages of NHL (I and II), when a reevaluation of the therapeutic strategy may be indicated . In stages III and IV of illness, it may also prove useful in evaluat ing the efficacy of chemotherapy.