Background/Aims: The thickened gastric wall are seen in a great number of benign and malignant conditions. Sometimes the differential diagnosis with either upper gastrointestinal X-ray or endoscopy of those lesions is difficult. We evaluated the usefulness of the endoscopic ultrasonogrphy (EUS) in the differential diagnosis for the thickened gastric wall of benign and malignant lesions. Methods: Fifty Borrmann type 4 advanced gastric cancers, 7 gastric lymphomas, 4 hypertrophic gastropathies, 3 acute gastric mucosal lesions, and one anisakiasis were included. We measured the full thickness of the gastric wall, the thickness of each layer and the preservation of the five-layered structure of the gastric wall, and then compared them with the endosonographic findings of 11 healthy controls. Results: Endosonographic findings of Borrmann type 4 advanced gastric cancers showed a diffuse thickening of all five layers, especially the third and fourth layers. Endosonographic findings of gastric lymphomas showed enlargement of the second, third, and fourth layers in 4 patients, the second and third layers in 1 patient, and only the second layer in 2 patients. The second layer was thickened in hypertrophic gastropathies, the second and third layers were thickened in acute gastric mucosal lesions, and the third layer was thickened in anisakiasis. The fourth ultrasound layer corresponding to the muscularis propria was significantly thickened only in malignant lesions. Conclusions: EUS can clearly visualize the wall architecture of the thickened gastric wall. EUS may be useful for the differential diagnosis of the thickened gastric wall and the differentiation of benign from malignant gastric lesions, (Korean J Gastrointest Endosc 2001;22:139 - 145)
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