Primary Intestinal Follicular Lymphoma Diagnosed by Double Balloon Endoscopy: Endoscopic Features and Treatment Outcomes

Objective: Little is known about the endoscopic features and clinical significance of small bowel (SB) lesions in primary intestinal follicular lymphoma (IFL). This study aimed to describe, based on a case series, detailed endoscopic features of SB lesions in IFLs and the relationship between clinical and histological stages. Methods: This retrospective study included 14 patients (8 females, median age, 61.5 years) newly diagnosed with IFL of SB. All patients underwent double balloon endoscopy (DBE), with both anterograde and retrograde approaches. Results: The distribution of IFLs in the GI tract were stomach 7%(1/14), duodenal bulb 7% (1/14), second part of the duodenum 93% (13/14), third part of the duodenum 86% (12/14), jejunum 93% (13/14), and ileum 43% (6/14). No colorectal lesions were detected. Multiple granules were the most frequently detected lesion, and were found in all patients. Nodule/mass lesions were detected in 5 patients. Nodule/mass lesions and ileal lesions were highly associated with the Lugano international classification. Eleven of 14 patients received chemotherapy plus Rituximab. Ten of 11 patients achieved complete response (CR). One patient achieved partial response (PR), but later exhibited disease progression. Four patients experienced grade 3 or 4 neutropenia, but all recovered without permanent side effects. One patient that achieved CR exhibited progressive disease after 54 months. All patients survived for a median of 35 months. Conclusions: DBE was necessary for the precise diagnosis of IFL involving the SB. Endoscopic features included a nodule/mass and ileal lesions, which were related to the clinical stage.