Endoscopic ultrasonography in the differential diagnosis of giant gastric folds

Giant gastric folds (or large gastric folds) are found in both benign and m alignant diseases, and differential diagnosis with either upper gastrointes tinal X-ray or endoscopy is difficult. Sometimes, even endoscopic biopsy ca nnot establish a definitive diagnosis. Recently, endoscopic ultrasonography (EUS) has been used to study giant gastric folds. We performed EUS in 25 p atients with giant gastric folds that had been detected with upper gastroin testinal X-ray or endoscopy. The definitive diagnoses were confirmed by his topathology, other examinations, or long-term follow-up. The final diagnose s of these 25 patients were gastric varices in eight, gastric lymphangiecta sis in one, gastritis in four, gastric carcinoma (scirrhous type) in six, a nd gastric lymphomas in six. All patients with gastric varices had anechoic tortuous varicose veins in the submucosal layer. EUS images of gastric lym phangiectasis were similar to those of gastric varices. EUS revealed regula r gastric wall thickening of the second (mucosa) and third (submucosa) laye rs in all cases of gastritis. The fourth (muscularis propria) layer was int act in the only case of mucosa-associated lymphoid tissue lymphoma (MALToma ), but not in the other five cases of gastric lymphoma. The second and thir d layers of this MALToma were irregular in thickness and heterogenous in ec hogenicity, different from the characteristic EUS findings in gastritis. Th e fourth layer was markedly thickened only in malignant conditions. Differe ntiation of gastric cancer from lymphoma with EUS was difficult because of overlapping EUS findings. In conclusion, EUS is indicated for the different ial diagnosis of giant gastric folds. In addition, it avoids the risk assoc iated with biopsy of gastric varices.