Endoscopic Findings and Follow-Up of Gastric MALT Lymphoma

No, Jin Hee; Lee, In Seok

Abstract

Gastric mucosa-associated lymphoid tissue (MALT) lymphomas comprise over 50% of primary gastric non-Hodgkin lymphomas and show an increasing incidence. Pathogenesis is often related to Helicobacter pylori infection (HPI). Howevere, endoscopic findings of MALT lymphoma are nonspecific and diagnosis is difficult by the naked eye due to various endoscopic appearances such as erosion, erythema, ulceration, atrophy and submucosal mass. Diagnosis is based on the histopathologic evaluation of multiple, deep and repeated biopsies taken from normal and any abnormal appearing sites of the stomach. Endoscopic ultrasound (EUS) can aid in accurate diagnosis, staging, and prediction of prognosis in gastric MALT lymphoma. After treatment of primary gastric lymphoma, EUS produces conflicting results that are not as accurate as endoscopy with biopsy. Therefore, EUS is not mandatory during follow-up. A first evaluation of lymphoma regression should be performed 3-6 months after completion of treatment. Further follow-up should be performed every 4-6 months thereafter until complete remission of lymphoma is documented. Gastroscopy with multiple biopsies has to be performed. Additionally, the initial sites of lymphoma involvement should be checked by appropriate methods. If complete remission of gastric MALT lymphoma is achieved, follow-up gastroscopies with biopsies seem advisable.