Characterization of Endoscopic Findings of Small Bowel Tumors and Clinical Usefulness of Double-Balloon Endoscopy

Abstract

Introduction: While 35 cases of small bowel tumor have been diagnosed since introduction of double balloon endoscopy (DBE) in our hospital, most cases of the disease were diagnosed at advanced stage with remarkable ulcerous lesion. To characterize endoscopic findings, we retrospectively analyzed endoscopic images of small bowel tumor cases diagnosed in our hospital. Methods: Based on the medical records, we retrospectively analyzed endoscopic images and patients' characteristics of 35 small bowel tumor cases diagnosed at Kyorin University hospital from 2005 to 2014. Results: In 35 cases, male-to-female ratio was 17:18 and mean age was 65.4 years. The reason for taking DBE was 21 of gastrointestinal bleeding of obscure origin (OGIB), 5 of ileus, 5 of tumorous lesions detected by other modalities, 2 of vomiting, and 2 of others. In the cases of OGIB, 15 cases were malignant tumors, and all of them were advanced stage. There was none of malignant tumor at earlier stage. Final diagnosis of 25 small bowel tumor cases were malignant tumors including 9 of GIST, 7 of adenocarcinoma, 4 of malignant lymphoma, 3 of metastatic small intestinal cancer, 2 of neuroendocrine tumor (NET). Other 10 cases were benign tumors. In the endoscopic images, submucosal tumor-like ridges with redness were observed in all 9 GIST cases including 6 cases with ulcer. All of the 7 adenocarcinoma cases were found as protruded lesions with ulcers. Irregular protruded lesions with ulcers were observed in all 4 malignant lymphoma cases. In a NET case, a protruded lesion with narrow-shaped ulcer was observed. As described above, ulcerous lesions with deep and wide range were concurrently observed in 22 of 35 small-bowel tumor cases, particularly, in malignant lymphoma, adenoma, and metastatic small-bowel tumor. About safety of DBE, perforation as complication was occurred only in a case of metastatic small bowel tumor. Conclusion: Although the majority of reason for DBE was OGIB, many cases were found at advanced stage in malignant cases. These lesions were often appeared as tumor with a wide range of ulcerous lesions. DBE is useful for pathological diagnosis of small bowel tumors, but further improvement is necessary for diagnosis of malignant tumor at earlier stage.