A Single Center Report on Detection of Small Bowel Tumors by Video Capsule Endoscopy

Abstract

Purpose: Small bowel tumors (SBTs) were previously estimated to account for just 1 to 3 % of all gastrointestinal (GI) cancers. With the advent of video capsule endoscopy (VCE), diagnostic yield for SBTs has improved, and their prevalence may be greater than these early figures. To date, there is little data on the identification of SBTs, and a true range of prevalence has yet to be defined. The objective of this study was to determine the prevalence, patient characteristics, post-capsule diagnostic measures and histopathology of SBTs in a single referral center. Methods: VCE studies from the University of California Davis Medical Center for 250 consecutive patients between January 2008 and December 2009 were retrospectively reviewed, and those patients with findings of suspected SBT were identified. Patient demographics and outcomes data including indication for referral, prior gastrointestinal imaging, follow-up intervention and histopathology were registered and analyzed. Results: Of the 250 patients, 4 (1.6%) patients had findings suspicious for SBT. The indication for VCE in 2 patients was obscure GI bleeding. One patient was referred with abdominal pain, weight loss and constipation, and another was referred for suspicion of a SB cancer after discovery of peritoneal carcinomatosis on CT scan. The average age was 62 years. There were 2 men and 2 women. Three of the patients had a cigarette smoking history. One of the two patients referred for obscure GI bleeding was on a combination of aspirin 81-mg and Plavix® 75-mg while the other was on aspirin 81-mg alone. Three of the patients had findings of “tumor” on capsule endoscopy, while one had findings of “ulcer.” One patient was lost to follow-up after hemodynamic instability led to abortion of push enteroscopy. All other patients underwent double balloon enteroscopy for biopsy. One patient was found to have a neuroendocrine carcinoma. Another patient was found to have an adenocarcinoma. One patient was found to have diffuse large B cell lymphoma. Conclusion: Capsule endoscopy is a notable advancement in the endoscopic identification of SBTs. Its utility may encompass the detection of primary malignancy in patients presenting with metastatic cancer. While most of the literature shows the detection of SBTs by VCE to range from 2.4% to 11.6%, the prevalence of SBTs by our study was 1.6%, suggesting the true range of prevalence may be broader than previously suspected. Overall, VCE is a safe and efficacious first-line modality for identifying SBTs and guiding further endoscopic intervention.