[Radiologic assessment of transpyloric spread of gastric carcinoma]

We report on our personal experience with the radiologic and CT demonstration of the traspyloric duodenal spread of gastric carcinoma, whose relative frequency and prognostic value are recent literature data.

In the last 4 years we submitted to double contrast studies of the upper gastrointestinal (GI) tract 49 gastric carcinoma patients with antrum involvement. Twenty-one cases were staged with CT performed with gastric water distension, pharmacological hypotonia and dynamic contrast agent perfusion. Finally, 41 patients underwent surgical treatment.

Radiologic evidence of transpyloric gastric carcinoma spread was found in 6 cases; CT, performed in 5 of them, was always in agreement. Five of 6 positive cases had surgical confirmation while one lesion was unresectable. No radiologic or CT false negatives were found among the remaining 36 surgical patients. Barium studies showed irregular antral lumen narrowing, rigid, open and eccentric pyloric channel, duodenal bulb deformity and irregular thickening. CT demonstrated antrum infiltration along the two gastric curvatures and the tumor spread to the duodenal cap.

Antral cancer transpyloric spread is more frequent than previously reported and its presence should not exclude a carcinomatous process. Double contrast barium studies are a valuable tool in the demonstration of this spread, showing good correlation with CT staging findings.