Significance of free perigastric fluid detected by echoendoscopy in patients with gastric cancer

Objectives: To determine the diagnostic value of free perigastric fluid identified by echoendoscopy in patients with gastric cancer and to establish the factors related to the presence of peritoneal carcinomatosis in these patients. Material and methods: We retrospectively included 100 patients with a histological diagnosis of gastric adenocarcinoma referred for echoendoscopy. A positive result was defined as the echoendoscopic identification of free perigastric fluid. This result was compared with the final study based on exploratory laparoscopy-laparotomy. The histological and endoscopic characteristics were compared with the final result. Results: Free perigastric fluid was found in 21 patients (21%). Among these, 15 (71%) showed peritoneal carcinomatosis, confirmed by laparoscopy (12 patients) or echoendoscopy-guided fine-needle-aspiration biopsy (three patients). In seven of the 79 patients (8%) not showing the presence of ascites, peritoneal implants were identified by exploratory laparoscopy-laparotomy. The sensitivity, specificity, positive predictive value and diagnostic accuracy of free fluid in the diagnosis of carcinomatosis was 68%, 92%, 71%, 91% and 87%, respectively. No histologic or endoscopic factors related to the malignancy of echoendoscopically-detected fluid were identified. Conclusion: In patients with gastric cancer, free perigastric fluid identified by echoendoscopy is an important predictive factor of peritoneal carcinomatosis and may have significant implications in the management of these patients. (C) 2012 Elsevier Espana, S.L. and AEEH y AEG. All rights reserved.