[Gastrointestinal amyloidosis: differential diagnosis and indications for surgical therapy]

The diagnosis of gastrointestinal amyloidosis may be difficult for both the radiologist and the examining surgeon because clinical symptoms are often uncharacteristic. Upper gastrointestinal series may show stenosing submucosal masses in the esophagus or gastric antrum with diminished peristalsis and pliability mimicking malignancies. With small bowel involvement, diminished motility and segmental or complete distension, a prolonged transit time, and eventually obstruction are common findings. In the present study, we report four cases of gastrointestinal amyloidosis and review the indications for operative treatment. Surgery should be avoided for abdominal pseudo-obstruction and but may be indicated in patients with gastrointestinal bleeding, perforation or other severe complications. The postoperative course is characterized by impaired wound healing, a high rate of heart and kidney failures, and considerable perioperative mortality. Thus, results are frequently unsatisfactory.