Abstract
Chemotherapy-induced diarrhea (CID) is a common, severe side effect of chemotherapy, immunotherapy, and targeted therapy. Because patients are more prone to continuing chemotherapy if they do not suffer from CID, appropriate diagnosis and monitoring of this disease are essential. However, suitable monitoring methods are yet to be developed. To date, several studies have shown that small-bowel capsule endoscopy (SBCE) is useful in visualizing the entire small intestinal mucosa and detecting small intestinal abnormalities, including bleeding, malignant tumors, and mucosal injury, associated with the use of nonsteroidal anti-inflammatory drugs and low-dose aspirin. Currently, limited studies have evaluated the small intestinal mucosa using SBCE in patients receiving fluoropyrimidine-based chemotherapy or immune checkpoint inhibitors. These studies have reported that small intestinal mucosal injury is common in patients with severe fluoropyrimidine-induced diarrhea. SBCE might be a useful screening method for the early detection of enterocolitis induced by immune checkpoint inhibitors. SBCE may be a powerful tool for the diagnosis and monitoring of CID, and understanding its indication, contraindication, and capsule-retention risk for each patient is important for clinicians.
Highlights
When diarrhea occurs during chemotherapy, its severity is primarily evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) (Table 1) [11]
Ota et al performed small-bowel capsule endoscopy (SBCE) in 16 patients with or without diarrhea and reported that the grade of diarrhea significantly correlated with the percentage of patients with a small intestinal mucosal break, which was defined as a mucosal defect [115]
They quantified the number of mucosal injuries, and the number of mucosal breaks was 6.5 and 0 in the oral fluoropyrimidine and 5-FU groups, respectively
Summary
Most patients with cancer receive curative or palliative chemotherapeutic intervention throughout their treatment course. Chemotherapy-induced diarrhea (CID) is one of the most common side effects of cancer therapy. Several studies have shown that SBCE can be used to visualize the entire small intestinal mucosa and detect abnormalities, including bleeding, malignant tumors, and mucosal injury, associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin [8,9,10]. These studies have shown a possible use of SBCE for the evaluation of small-intestinal abnormalities in patients with. This review sought to summarize the current state of literature on CID, with a focus on gastrointestinal cancer and the future possibility of using SBCE for the diagnosis and monitoring of CID
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