Utility of Video Capsule Endoscopy (VCE) in the Detection of Small Bowel (SB) Tumors – A Single Center Experience

Abstract

Purpose: True incidence of SB tumors is unknown; they are usually diagnosed at an advanced stage or incidentally at laparotomy. This may relate to length of SB and lack of endoscopic modalities. VCE visualizes entire SB & may be useful in detection of SB tumors. Objective: Determine prevalence of SB tumors in patients undergoing VCE, define endoscopic & pathologic findings, & patient outcomes. Methods: Retrospective review of patients who had VCE at our institution from 9/6/01 to 1/4/06. Results: 61/860 (7%) patients who underwent VCE had findings of SB tumor/polypoid lesion. 14/860 (2%) had confirmed tumor by CT scan, endoscopy &/or surgery. Of remaining 47 patients, lipoma (6), negative follow-up endoscopy (push or double balloon endoscopy) (16) & lesions of unclear significance without follow-up (25). Mean age of patients with confirmed tumors was 67 yrs (SD 9.9); 9M/5F. Ten patients (71%) with obscure overt GI bleed (7 melena; 2 hematochezia), 2 (14%) occult GI bleed, 1 (7%) abdominal pain & diarrhea, and 1 (7%) surveillance of FAP. Tumor/polypoid mass on VCE in 9 patients (64%), ulcer in 2 (14%), ulcerated nodules in 1 (7%), extrinsic compression in 1 (7%) and poor visualization in 1 (7%). Capsule impaction at tumor site occurred in 4 (29%) patients. Proximal SB was involved in 4 (29%), mid SB in 7 (50%) & multiple lesions throughout SB in 3 patients (21%). CT enterography performed in 7 patients confirmed VCE findings. 13 patients (93%) had surgery; successful resection of tumor in 8/12 (62%). Pathology included adenocarcinoma, lymphangioma & carcinoid in 2 patients each (14%), diffuse large B cell lymphoma (7%), enteropathy associated T cell lymphoma (7%), GIST (7%), seranaplastic tumor (ovarian) (7%), endometrial stromal sarcoma (7%) & leiomyoma (7%). Pathology unavailable in 2;1 (7%) with presumed metastases from rectal cancer. Accuracy of tumor location with VCE 82% (9/11 patients). IC valve reached in only 43% patients. Conclusions: 2% of patients who underwent VCE had SB tumor confirmed by endoscopy or surgery. 85% of tumors were malignant, most common adenocarcinoma, lymphoma & carcinoid. VCE proved to be a useful noninvasive modality that facilitated early detection & successful resection of SB tumors. VCE retention rate was high (29%)with colon reached in only 43% of patients.