Miura Shogo, Kuroda Hiroyuki, Sato Ken, Yamada Michiko, Itou Ryo, Ono Michihiro, Abe Tomoyuki, Fujii Shigeyuki, Maeda Masahiro, Yoshida Masahiro, Jomen Wataru, Kobune Masayoshi, Kato Junji, Fujita Miri
Department of Gastroenterology and Hematology/Clinical Oncology, Internal Medicine, Steel Memorial Muroran Hospital.
Department of Medical Oncology and Hematology, Sapporo Medical University.
Rinsho Ketsueki. 2018;59(1):27-32. doi: 10.11406/rinketsu.59.27.
The gastrointestinal tract is a common site for the occurrence of non-Hodgkin's lymphoma (NHL). NHL with gastrointestinal lesions may lead to clinically relevant intestinal complications such as obstruction, perforation, and exsanguination during the course of the disease. Consequently, patients with NHL are often examined by means of upper and lower gastrointestinal endoscopy at the initial visit. There are no clear guidelines regarding which patients should undergo capsule endoscopy (CE) and balloon enteroscopy for detecting small intestinal lesions. We retrospectively examined the feasibility of detecting small intestinal lesions in NHL using upper and lower gastrointestinal endoscopy. Between January 2007 and October 2015, 198 patients with primary NHL were admitted to our hospital. We collected data from 51 patients with NHL with gastrointestinal lesions diagnosed through upper and lower gastrointestinal endoscopy, CE, or double balloon enteroscopy (DBE). We chosed these cases that gastrointestinal lesions was doubted by an examination for image. Nineteen of these patients presented with lymphoma at the duodenal bulb/descending part when examined by upper gastrointestinal endoscopy and at the distal ileum when examined by lower gastrointestinal endoscopy. Ectopic jejunoileal lymphoma was simultaneously detected in 13 of the 19 patients (68.4%) through the use of CE or DBE. Conversely, of the 32 patients who did not exhibit lesions at the duodenal bulb/descending part or at the distal ileum, 6 patients (18.8%) presented with small intestinal lesions, indicating a smaller percentage compared to the patients with ectopic jejunoileal lymphoma. Based on these findings, a proactive search for small intestinal lesions using CE or DBE is recommended in patients with NHL presenting with lymphoma at the duodenal bulb/descending part or at the distal ileum, as examined using both upper and lower gastrointestinal endoscopy during the initial visit.
胃肠道是非霍奇金淋巴瘤（NHL）的常见发病部位。伴有胃肠道病变的NHL在疾病过程中可能导致临床上相关的肠道并发症，如梗阻、穿孔和出血。因此，NHL患者在初次就诊时通常会接受上消化道和下消化道内镜检查。关于哪些患者应接受胶囊内镜（CE）和气囊小肠镜检查以检测小肠病变，目前尚无明确的指南。我们回顾性研究了使用上消化道和下消化道内镜检测NHL患者小肠病变的可行性。2007年1月至2015年10月期间，198例原发性NHL患者入住我院。我们收集了51例经上消化道和下消化道内镜、CE或双气囊小肠镜（DBE）诊断为伴有胃肠道病变的NHL患者的数据。我们选择了这些经影像学检查怀疑有胃肠道病变的病例。其中19例患者在上消化道内镜检查时十二指肠球部/降部出现淋巴瘤，在下消化道内镜检查时回肠末端出现淋巴瘤。通过CE或DBE检查，在这19例患者中有13例（68.4%）同时检测到空回肠异位淋巴瘤。相反，在32例十二指肠球部/降部或回肠末端未出现病变的患者中，有6例（18.8%）出现小肠病变，与空回肠异位淋巴瘤患者相比，这一比例较低。基于这些发现，对于初次就诊时经上消化道和下消化道内镜检查发现十二指肠球部/降部或回肠末端出现淋巴瘤的NHL患者，建议使用CE或DBE积极寻找小肠病变。
