Double-Balloon Endoscopy for Diagnoses of Small Bowel Tumors

Abstract

Backgrounds and Aims: Small bowel tumors accounts for only 1-2% of all gastrointestinal tumors. In addition, small bowel tumors often go undiagnosed, given the limitations of traditional endoscopy, and radiological procedures such as enteroclysis and CT scan, in visualizing the small intestine. Furthermore, the relative inaccessibility of the small intestine precludes easy retrieval of samples for histopathological analysis without resorting to surgery. Yamamoto et al. have developed a new endoscopy system, called double-balloon endoscopy (DBES), which enables endoscopic scrutiny and treatment of the entire small bowel. The aim of this study was to evaluate the value and potential of this endoscopic system in the diagnosis of small bowel tumors. Patients and Methods: The DBES (EN-450P5/20, EN-450T5/20, Fujinon, Fuji Photo Optical Co., Ltd., Saitama, Japan) was used to perform 90 enteroscopies in 65 patients between June 2003 and November 2004 at Nippon Medical School Hospital. The system was assessed on the basis of diagnostic yields and complications. Results: Small bowel tumors were detected in 8 (12%) of 65 patients. Forceps biopsy specimens were obtained through DBES and histopathological examination was possible in all 8 patients. Of the 8 patients, 5 were males and 3 females, with ages ranging from 42 to 82 years (average, 65 years). Chief complaints were gastrointestinal bleeding in 5 patients, anemia in 2 patients and diarrhea in 1 patient. The tumors were located in the jejunum in 3 patients, and in the ileum in 5 patients. Tumors were diagnosed histopathologically as: gastrointestinal tumor (GIST) in 5 (67%) patients, malignant lymphoma in 2 (25%) patients and adenocarcinoma in 1 (12%) patient. Of the 5 patients with GIST, 4 had celiotomy and 1 had celiotomy, with subsequent adjuvant chemotherapy. Of the 2 patients with malignant lymphoma, one patient had chemotherapy; the other, celiotomy, with subsequent adjuvant chemotherapy. One patient with adenocarcinoma had laparoscopic enterectomy. We encountered no complications during DBES procedures. Conclusions: DBES allows through examination of the entire small bowel, with a 100% success rate of histopathlogical assessment endoscopically. The procedure is safe and of great diagnostic value and aids in the appropriate selection of therapeutic modalities.