What does routine upper gastrointestinal endoscopy contribute to the staging of non Hodgkin's lymphoma?

In view of the discrepancy between the incidence of gastrointestinal involvement by malignant lymphomas, as established in postmortem studies, and the rareness of the corresponding clinical diagnosis, we carried out routine upper gastrointestinal endoscopy in 82 consecutive patients with newly diagnosed non-Hodgkin's lymphoma. 11/40 patients (27.5%) with non-Hodgkin's lymphoma of low-grade malignancy, and 11/42 (26.2%) of those with highly malignant non-Hodgkin's lymphoma revealed involvement of the gastric and/or duodenal mucosa, as diagnosed by oesophagogastroduodenoscopy. Two patients in stage III, two in stage II, and two further patients with presumptive stage I had to be reclassified as stage IV. Due to gastrointestinal involvement, two patients changed from radiation to chemotherapy, and another two patients underwent gastric resections to avoid possible treatment related complications. In the light of these results and the fact that a major basis for the therapeutic strategy in non-Hodgkin's lymphomas represents tumor stage, routine oesophagogastroduodenscopy within the framework of the usual staging examinations should be discussed. In the individual case, this procedure may be of decisive importance for the therapeutic approach and the prevention of complications.