Multimodal Endoscopic Ultrasound in the Evaluation of Indeterminate Upper Gastrointestinal Wall Thickening
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Endoscopic ultrasound.
- Who it may be relevant to
- Registry conditions: Upper Gastrointestinal Wall Thickening. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Egypt
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Official title
Multimodal Endoscopic Ultrasound in the Evaluation of the Nature of Indeterminate Upper Gastrointestinal Wall Thickening
Overview
Multimodal endoscopic ultrasound can help to differentiate between benign (non-cancerous) and malignant (cancerous) causes of thickening of the upper digestive tract wall. The main questions this study aims to answer are: How accurate is multimodal endoscopic ultrasound in identifying the cause of upper digestive tract wall thickening? Can using several ultrasound techniques together improve diagnosis when standard tests are unclear? Participants are adults who have upper digestive tract wall thickening seen on scans such as computed tomography (CT) or magnetic resonance imaging (MRI). Participants will: Undergo upper endoscopy followed by endoscopic ultrasound and tissue sample taken during the procedure when needed followed by using biopsy results or clinical follow-up to confirm the final diagnosis This study aims to improve early and accurate diagnosis and help guide proper treatment decisions for people with unexplained upper digestive tract wall thickening.
Detailed description
Upper gastrointestinal wall thickening (UGIT) refers to the abnormal increase in the thickness of the gastrointestinal wall, which can be observed in various clinical conditions, including both benign and malignant diseases (1).
Abnormal gastric wall thickening can be caused by a wide range of benign and malignant conditions, and expedient diagnosis is required to commence the appropriate treatment (2, 3).
Traditional diagnostic approaches for evaluating UGIT rely primarily on cross-sectional imaging techniques such as contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI). However, these modalities often lack sufficient spatial resolution to accurately characterize the individual layers of the gastrointestinal wall, particularly in cases of subtle mucosal or submucosal disease (4, 5).
Esophagogastroduodenoscopy (EGD) allows direct visualization of the mucosal surface and enables tissue sampling through conventional biopsies. Nevertheless, many pathological processes responsible for gastrointestinal wall thickening-such as gastric lymphoma, subepithelial tumors, linitis plastica, and infiltrative scirrhous carcinoma-originate in the deeper layers of the gastrointestinal wall (6).
EUS allows clear delineation of the gastrointestinal wall layers and surrounding structures. EUS-guided tissue acquisition using fine-needle biopsy (FNB) allows sampling of submucosal and muscular lesions that are inaccessible to conventional endoscopic biopsies (1).
Interventions
- Procedure Endoscopic ultrasound
Multimodal Endoscopic Ultrasound including; conventional B-mode EUS Assessment, doppler evaluation, EUS elastography and Selective EUS-Guided Fine-Needle Biopsy (EUS-FNB)
Primary outcome measures
- Diagnostic accuracy of multimodal EUS [Time frame: one year]
Secondary outcome measures (3)
- EUS imaging patterns associated with various etiologies. [Time frame: one year]
- Incremental diagnostic value of elastography. [Time frame: one year]
- Diagnostic yield of EUS-guided tissue acquisition. [Time frame: one year]
Eligibility criteria
Inclusion criteria
- Age ≥18 years
- Patients with endoscopic or radiological (U/S, CT or MRI) evidence of upper GI wall thickening (esophagus, stomach, or duodenum) and defined based on established radiologic standards. A wall thickness by MSCT >5 mm in the oesophagus and stomach and >4 mm in the duodenum in accordance with accepted CT imaging criteria (4, 7).
- Written informed consent provided.
Exclusion criteria
- Patient refusal or inability to provide informed consent
- Uncorrectable coagulation disorder e.g prothrombin concentration <60%, INR >1.5 or platelet count <50,000/µL that cannot be corrected pre-procedure according to institutional guidelines.
- Presence of contraindications for endoscopy/sedation.
- Known diagnosis explaining wall thickening prior to EUS.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Cohort
Study locations
Egypt · 1 center
- Assiut University — Asyut
Publications
- Desai RK, Tagliabue JR, Wegryn SA, Einstein DM. CT evaluation of wall thickening in the alimentary tract. Radiographics. 1991 Sep;11(5):771-83; discussion 784. doi: 10.1148/radiographics.11.5.1947313. PMID 1947313
- Tellez-Avila FI, Duarte-Medrano G, Lopez-Arce G, Herrera-Mora D, Ramirez-Luna MA, Valdovinos-Andraca F, Elizondo-Rivera J. EUS-guided tissue samples for the diagnosis of patients with a thickened gastric wall and prior negative endoscopic biopsies. Acta Gastroenterol Belg. 2019 Jul-Sep;82(3):359-362. PMID 31566322
- Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol. 2001 May;176(5):1105-16. doi: 10.2214/ajr.176.5.1761105. No abstract available. PMID 11312162
- Ergin M, Kivrakoglu F. Evaluation of Endoscopic Findings in Gastrointestinal Tract Wall Thickening Detected on Abdominal Radiological Imaging: A Two-Center Retrospective Descriptive Study. Medicina (Kaunas). 2025 Sep 18;61(9):1699. doi: 10.3390/medicina61091699. PMID 41011090
- Jung K, Park MI, Kim SE, Park SJ. Borrmann Type 4 Advanced Gastric Cancer: Focus on the Development of Scirrhous Gastric Cancer. Clin Endosc. 2016 Jul;49(4):336-45. doi: 10.5946/ce.2016.057. Epub 2016 Jul 25. PMID 27456608
- Chen TK, Wu CH, Lee CL, Lai YC, Yang SS. Endoscopic ultrasonography in the differential diagnosis of giant gastric folds. J Formos Med Assoc. 1999 Apr;98(4):261-4. PMID 10389370
- Giri S, Narayan J, Angadi S, Shah B, Ingle M, B K, Tyagi U, Kumar L, Wu CCH, Bhrugumalla S, Sundaram S. Role of endoscopic ultrasound-guided tissue acquisition for the diagnosis of gastric wall thickening: a retrospective study with meta-analysis. Ann Gastroenterol. 2023 Nov-Dec;36(6):605-614. doi: 10.20524/aog.2023.0831. Epub 2023 Nov 3. PMID 38023968
Identifiers
NCT: NCT07407296 · MM-EUS-UGIWT