[Diagnosis and therapy of gastrointestinal Kaposi's sarcoma in AIDS]

Gastrointestinal Kaposi's sarcoma (KS) is one of the most frequent neoplastic diseases seen in AIDS. Visceral involvement is associated with shorter survival as compared to cutaneous KS. Our aim was therefore to investigate patients with KS endoscopically. In order to improve the early diagnosis of gastrointestinal KS we also employed endoscopic ultrasonographic examinations (EUS). 22 patients recruited for a prospective trial addressing this issue were examined by endoscopy and by EUS. 21 patients had severe cutaneous KS, one patient had no cutaneous KS but showed signs and symptoms of gastrointestinal KS. 15/22 patients (68%) had gastrointestinal KS. Seven patients (32%) had endoscopically normal mucosa. In 2 patients only EUS showed findings suggestive for KS which had not been seen by endoscopy. Follow-up examinations proved typical KS lesions endoscopically in those 2 patients. Using liposomal encapsulated Doxorubicin within a trial (20 mg/m2 intravenously every 3 weeks), we were able to follow 3 patients prior to and during therapy. EUS showed a significant reduction in number and volume of KS lesions as well as a reduction of infiltration depth. In one patient macroscopic and histologic examinations showed complete remission. We conclude that EUS of the upper gastrointestinal tract can be used as a sensitive method for the detection of early gastrointestinal KS. Furthermore, EUS is a method which allows determination of tumor volume and helps in quantification of tumor response after chemotherapy.