Role of Mucosal Protrusion Angle in Discriminating between True and False Masses of the Small Bowel on Video Capsule Endoscopy.

May Min,David Cave,Christopher Schlieve,Aditya Vaze,Jonathan Green,Michael Noujaim,Mitchell Cahan

doi:10.3390/jcm8040418

Abstract

The diagnosis of small-bowel tumors is challenging due to their low incidence, nonspecific presentation, and limitations of traditional endoscopic techniques. In our study, we examined the utility of the mucosal protrusion angle in differentiating between true submucosal masses and bulges of the small bowel on video capsule endoscopy. We retrospectively reviewed video capsule endoscopies of 34 patients who had suspected small-bowel lesions between 2002 and 2017. Mucosal protrusion angles were defined as the angle between the small-bowel protruding lesion and surrounding mucosa and were measured using a protractor placed on a computer screen. We found that 25 patients were found to have true submucosal masses based on pathology and 9 patients had innocent bulges due to extrinsic compression. True submucosal masses had an average measured protrusion angle of 45.7 degrees ± 20.8 whereas innocent bulges had an average protrusion angle of 108.6 degrees ± 16.3 (p < 0.0001; unpaired t-test). Acute angle of protrusion accurately discriminated between true submucosal masses and extrinsic compression bulges on Fisher’s exact test (p = 0.0001). Our findings suggest that mucosal protrusion angle is a simple and useful tool for differentiating between true masses and innocent bulges of the small bowel.

Highlights

The diagnosis of small-bowel tumors is challenging due to their low incidence, nonspecific clinical presentation, and the limitations of traditional endoscopic techniques
Video capsule endoscopy (VCE) has dramatically improved our ability to detect small-bowel tumors by enabling the visualization of portions of the small-bowel that are not accessible by colonoscopy or upper endoscopy [1]
In the absence of these features, it can be challenging to differentiate between true submucosal masses and benign bulges arising from extrinsic compression by adjacent structures

Summary

Introduction

The diagnosis of small-bowel tumors is challenging due to their low incidence, nonspecific clinical presentation, and the limitations of traditional endoscopic techniques. Video capsule endoscopy (VCE) has dramatically improved our ability to detect small-bowel tumors by enabling the visualization of portions of the small-bowel that are not accessible by colonoscopy or upper endoscopy [1]. VCE missed only 10% of small-bowel tumors compared to a collective miss rate of 73% by double balloon enteroscopy, small-bowel series, colonoscopy, and ileoscopy [3]. One of the major limitations of VCE is its inability to biopsy lesions identified during passage through the small bowel. A group of experts at the 2006 International Conference on Capsule Endoscopy identified several major and minor characteristics of small-bowel lesions that are predictive of tumors, including mucosal disruption, bleeding, irregular surface, polypoid appearance, color, delayed passage, white villi, and invagination [4]. In the absence of these features, it can be challenging to differentiate between true submucosal masses and benign bulges arising from extrinsic compression by adjacent structures

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Discussion

Conclusion