Is it worthwhile to fully evaluate the stomach in every ultrasound examination of the abdominal cavity?

Abstract

Background/objective: To evaluate the usefulness of abdominal sonography in the fasting state with no hypotonic agents in the detection and exclusion of gastric lesions.

Patients and methods: One-hundred patients with normal upper gastrointestinal endoscopy, 94 patients with a major gastric abnormality (including 59 intraluminal tumors, three submucosal masses, 29 ulcers, two polyps and one hypertrophied gastric mucosa) and 75 patients with minor gastric abnormalities (mainly gastritis) were enrolled into the study.

Results: Of the 100 normal patients, ultrasound showed four false positive results with 96% specificity of the examination. Within the major gastric lesion group, ultrasound was true positive in 55 of 59 tumors, 15 of 29 ulcers, three of three submucosal masses and the case of giant gastric mucosa. It was negative in the detection of gastric polyps. It could detect only 8% of minor gastric abnormalities.

Conclusion: Abdominal sonography in the fasting state, if carefully performed, is sufficiently accurate in detection and exclusion of major gastric lesions. Therefore, although it cannot replace endoscopic and barium studies of the stomach, careful evaluation of the stomach is recommended in every sonographic evaluation of the abdominal cavity.

Keywords: Abdominal Cavity; Gastrointestinal Endoscopy; Sensitivity; Specificity; Ultrasonography.

Fig. 1

Transverse abdominal ultrasound image in a healthy 38-year-old woman demonstrating normal hypoechoic gastric wall thickness of less than 5 mm.

Fig. 2

Abdominal ultrasound images showing gastric adenocarcinomas in fundus A, body B and antrum C,D of the stomach. E. The barium meal image of case A

Fig. 3

Malignant gastric ulcer in a 55-year-old man.( (A) Shows barium meal in this patient. (B) Abdominal sonography shows thickening of the gastric wall associated with a fixed echogenic area (arrow in B) probably representing the ulcer crater.)

Fig. 4

Gastric adenocarcinoma in a 68-year-old man. Longitudinal (A) and transverse (B) abdominal ultrasound images show gastric antrum wall thickening in association with fluid distention in the proximal parts of the stomach.

Fig. 5

Abdominal ultrasound (A) and barium meal (B) images in a 47year-old lady with gastric wall leiomyoma. In another similar case (C), ultrasound image shows displacement of the gastric lumen (GL) gas by the submucosal mass lesion (M).

Fig. 6

Abdominal ultrasound (A) and barium meal (B) images demonstrating giant hypertrophy of the gastric mucosal folds in a 52-year-old man, probably related to chronic alcohol consumption.

Fig. 7

Abdominal ultrasound image in a 48-year-old female with benign lesser curvature gastric ulcer showing thickening of the gastric wall and a niche-like echogenicity (arrow), probably representing the ulcer carter.