Small Bowel Tumors Detected By Video Capsule Endoscopy (VCE): Preliminary Data from the ECEG (European Capsule Endoscopy Group) Database

Abstract

Background: Small bowel (SB) tumours account for little more than 1% of GI neoplasms. These malignancies become symptomatic after a long silent phase and often represent a diagnostic challenge. Recently, the endoscopic evaluation of the SB became easier, painless and safe because of the introduction of the Video Capsule Endoscopy (VCE) in clinical practice. This diagnostic tool identified more small bowel neoplasms than previously expected. Aim of the study: To describe the clinical presentation, the diagnostic work-up, the endoscopic appearance of SB tumours identified by VCE in a large population of patients. Patients and methods: We collected patients with capsule endoscopy findings suggesting SB tumours and further histological confirmation of the neoplasm. Results: Among 3031 VCE performed in 17 centres of 6 European countries, we identified 74 patients (2.4%) (32F, 42 M, mean age 59,0 + 14,7 years) with a diagnosis of small bowel tumour. In these patients the indication for VCE was obscure GI bleeding in 67 (90.5%): obscure-occult in 39,2%, obscure overt in 32,4% and previous overt in 18,9%, abdominal pain in 4 (5,5%) and research for primitive neoplasm in 3 patients with liver metastases (4%). 17 patients (23%) underwent VCE as the third test after a negative bidirectional endoscopy while 57 (62,2%) performed at least one further examination of the SB before VCE. The endoscopic appearance of lesions identified by VCE was: polyps in 67,7%, ulcers in 12,1%, stenoses 10,8%, fresh blood in 6,7% and cobblestone in 2,8%. The lesions were single in 87,6% of cases (63,1%, located in the jejunum, 32,3% in the ileum and 4,6% in the duodenum) and multiple in 9,4%. The VCE was retained and surgically removed in 10,9% of patients. 66 of 74 lesions identified were primitive neoplasm (36,6% GISTs, 16,6% carcinoids, 13,6% adenocarcinomas and 33,2% other SB tumours) while the other 8 cases were SB metastases (5 cases of melanoma, 1 colonic carcinoma, 1 hepatocellular carcinoma and 1 seminoma). After VCE, 32 patients were operated on while 34 underwent another diagnostic examination before surgery; 4 patients underwent chemotherapy. Conclusions: The prevalence of SB tumours in patients underwent VCE is 2,4%. In patients with SB tumours the main indication for VCE was obscure GI bleeding; in about one quarter of cases VCE represented the third examination after negative bidirectional endoscopy. These neoplasms appear frequently as a polyp and in 10% of cases lead the capsule retention. GIST was the most frequent primitive small bowel neoplasm. The treatment, often based only on capsule endoscopy findings, was surgical in 93% of cases.