Linitis plastica diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

There is no single diagnostic study of choice for the diagnosis of linitis plastica, but linitis plastica can be diagnosed based on upper gastrointestinal endoscopy (upper GI endoscopy) and barium meal studies. Linitis plastica is often missed on upper GI endoscopies, it is imperative that bite and strip biopsies are carried out in order to prevent false negatives. Barium study may be superior to upper GI endoscopy in the case of diffuse adenocarcinoma of the stomach, as a lack of distensibility and flask-shaped appearance of the stomach may be detected.

Diagnostic study of choice

Gold standard/Study of choice:

There is no single diagnostic study of choice for the diagnosis of linitis plastica, but linitis plastica can be diagnosed based on upper gastrointestinal endoscopy (upper GI endoscopy) and barium meal.[1]

Diagnostic results
  • The following result of upper GI endoscopy is confirmatory of linitis plastica:[1]
  • The following result of barium study is confirmatory of linitis plastica:
    • Leather-flask appearance of the stomach with a lack of distensibility.
Sequence of Diagnostic Studies

The upper GI endoscopy should be performed when:[2]

  • The patient presented with symptoms of weight loss, anorexia and early satiety as the first step of diagnosis.
  • A positive biopsy is detected in the patient, to confirm the diagnosis.
  • However, the upper GI endoscopy may give a false negative result in the case of linitis plastica.
  • Therefore, bite and strip biopsies must be carried out to minimize the occurence of false negatives.

The barium meal should be performed when:

  • Diffuse adenocarcinoma is suspected and the upper GI endoscopy is negative.
  • An indistensible, leather bottle appearance of the stomach is detected in the patient, to confirm the diagnosis.

Diagnostic Criteria

There are no established criteria for the diagnosis of linitis plastica.

References

  1. 1.0 1.1 Graham DY, Schwartz JT, Cain GD, Gyorkey F (1982). "Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma". Gastroenterology. 82 (2): 228–31. PMID 7054024.
  2. Karita M, Tada M (1994). "Endoscopic and histologic diagnosis of submucosal tumors of the gastrointestinal tract using combined strip biopsy and bite biopsy". Gastrointest. Endosc. 40 (6): 749–53. PMID 7859977.



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