Capsule Endoscopy in Patients With Malignant Melanoma

Abstract

Although small bowel (SB) involvement is found at postmortem in 50-60% of melanoma patients, diagnosis is only made during life in 10% of cases. This study reports the findings of capsule endoscopy (CE) in melanoma patients referred for investigation of suspected SB involvement. Eight men and five women with known or previous melanoma were referred for CE between December 2003 and September 2006. The indications were gastrointestinal bleeding (three), anemia (six), positive fecal occult blood test (one), abnormal imaging (two), and abdominal pain (one). CE showed SB metastases in five patients and excluded SB involvement in eight. All patients had previous investigations with either endoscopy, push enteroscopy, SB follow-through, CT scan, and/or PET scan. CE showed new lesions not detected by other investigation modalities. CE also ruled out SB metastases when other tests were nondiagnostic. All five patients with SB metastases detected underwent surgical resection. At follow-up after CE of a mean 8.4 months (1-23 months) and 4.9 months (0.25-10 months) after surgery, five patients had died, including three of those who had undergone resection of SB metastases. Seven patients were still alive, including two who had SB surgery. One patient was lost to follow-up. CE may detect the presence and extent of SB metastases in patients with melanoma more reliably than conventional investigations. It should be considered in the workup of melanoma patients with suspected SB disease.