Usefullness of Videocapsule Study in Small Bowel Malignancy

Abstract

Background and Aim: early diagnosis of small bowel tumors is very important for curative surgery. Videocapsule endoscopy has enormously improved the diagnosis of small bowel diseases, but there are few data about the role of this examination in small bowel malignancies. Aim of this study is to evaluate the diagnostic yield of videocapsule endoscopy in small bowel malignancies. Patients and Methods: from December 2002 to April 2006 370 patients were consecutively studied with videocapsule endoscopy in our centre; data of 11 consecutive patients (M/F: 6/5, mean age 58 years, range 34-77) affected by small bowel malignancy were retrospectively assessed. Results: indication for videocapsule endoscopy in these patients was: obscure-overt bleeding in 5/11 (45.4%), obscure occult bleeding in 3/11 (27.3%), abdominal pain in 1/11 (9.1%), celiac disease in 1/11 (9.1%), long-lasting fever in suspected neoplasia in 1/11 (9.1%). Before capsule endoscopy patients had undergone overall 54 procedures (EGD, colonoscopy, SBFT, abdominal CT scan, Technetium tc 99m-labeled RBC scintigraphy). Capsule endoscopy findings were: jejunal polyps in 6 (54.5%) and in particular 2 ulcerated polyps, 2 bleeding polyps and 1 ulcerated and actively bleeding polyp; suspected lymphoma in 2 (18.2%); ileal active bleeding 1 (9.1%); bleeding and ulcerated stricture in 1 (9.1); suspected Crohn's disease in 1 (9.1%). The diagnosis was confirmed after surgery in 10 cases (surgery confirmation is not available in 1 patient who died for stroke 3 days after videocapsule examination). Histological examinations revealed: GIST in 2, lymphoma in 2, carcinoid in 2, jejunal adenocarcinoma in 1, metastatic melanoma in 1, metastatic rectal adenocarcinoma in 1, peritoneal carcinosis infiltrating jejunal loops in 1. In 10/11 patients videocapsule examination changed the therapy and the outcome. 10 patients are still alive and in good health conditions. Conclusions: small bowel tumors are a rare disease. Videocapsule endoscopy is able to detect tumors that are often missed by traditional examinations and has a relevant impact on therapy and outcome.