Diagnosis Of Small Bowel Tumors Research Articles

Endoscopic Diagnosis of Small Bowel Tumor.

Recent technological advances, including capsule endoscopy (CE) and balloon-assisted endoscopy (BAE), have revealed that small intestinal disease is more common than previously thought. CE has advantages, including a high diagnostic yield, discomfort-free, outpatient basis, and physiological images. BAE enabled endoscopic diagnosis and treatment in the deep small bowel. Computed tomography (CT) enterography with negative oral contrast can evaluate masses, wall thickening, and narrowing of the small intestine. In addition, enhanced CT can detect abnormalities outside the gastrointestinal tract that endoscopy cannot evaluate. Each modality has its advantages and disadvantages, and a good combination of multiple modalities leads to an accurate diagnosis. As a first-line modality, three-phase enhanced CT is preferred. If CT shows a mass, stenosis, or wall thickening, a BAE should be selected. If there are no abnormal findings on CT and no obstructive symptoms, CE should be selected. If there are significant findings in the CE, determine the indication for BAE and its insertion route based on these findings. Early diagnosis of small intestinal tumors is essential for favorable outcomes. For early diagnosis, the possibility of small bowel lesions should be considered in patients with unexplained symptoms and signs after examination of the upper and lower gastrointestinal tract.

Symptoms Contributing to the Diagnosis of Small Bowel Tumors

Introduction: Small bowel tumors (SBTs) are difficult to diagnose because of limited opportunities and technical difficulties in evaluating the small bowel. Asymptomatic conditions or nonspecific symptoms make SBT diagnosis more challenging. In Asia, SBTs are reported to be more frequently malignant lymphoma (ML), adenocarcinoma, and gastrointestinal stromal tumor (GIST). In this study, we examined 66 patients diagnosed with SBTs and determined their clinical characteristics. Methods: This retrospective study was conducted from January 2013 to July 2020 at Kurume University Hospital. The modalities used to detect SBTs were computed tomography (CT), positron emission tomography, magnetic resonance imaging, and ultrasonography. Endoscopy was also performed in some cases to confirm SBT diagnosis. The study included 66 patients. The medical data collected included presenting symptoms, tumor location, underlying condition, diagnostic modalities, pathologic diagnosis, and treatment. Results: ML and adenocarcinoma were the most common tumors (22.7%), followed by GIST (21.2%) and metastatic SBT (18.2%). Symptoms that led to SBT detection were abdominal pain (44.5%), asymptomatic conditions (28.8%), hematochezia (12.1%), and anemia (10.6%). CT was the most used modality to detect SBTs. Nineteen patients were asymptomatic, and SBTs were incidentally detected in them. GISTs and benign tumors were more often asymptomatic than other malignant tumors. Conclusion: Abdominal pain was the main symptom for SBTs in particular adenocarcinoma, ML, and metastatic SBT. In addition, GIST, which was highly prevalent in Asia, had fewer symptoms. An understanding of these characteristics may be helpful in the clinical practice of SBTs.

Imaging of Small Bowel Tumors and Mimics

AbstractSmall bowel tumors are rare with nonspecific and protean clinical presentation. Early diagnosis of small bowel tumors is desirable as they can be associated with significant morbidity. In malignant small bowel tumors, delayed diagnosis may result in dissemination and metastasis leading to poor clinical outcomes. Imaging evaluation of small bowel can be challenging due to unpredictable luminal distension, peristalsis, and motion. In addition, the lack of distinction between the intraluminal lesions and intraluminal contents can be difficult at times. Computed tomography (CT) and magnetic resonance (MR) enterography are the most common imaging techniques for the evaluation of small bowel tumors. While these techniques may not be able to detect small tumors, they provide comprehensive evaluation of lumen, wall, and extramural structures in tumors more than 2 cm. Acquaintance of imaging appearance of common benign and malignant small bowel tumors may allow improved detection during evaluation of CT and MR enterography studies. In this review, we discuss the imaging appearances, approach, and differential diagnosis of small bowel tumors on cross-sectional imaging studies.

S2887 Diffuse Large B-Cell Lymphoma Presenting as Jejunal Diverticulitis on Imaging

INTRODUCTION: Small bowel tumors comprise of only 5% of all neoplasms in the gastrointestinal tract. The diagnosis of small bowel tumors is often difficult due to the rarity of these lesions and the non-specific and variable presenting signs and symptoms. This can lead to a delay in diagnosis and poor treatment outcome. Frequently, small bowel tumors are diagnosed on imaging and confirmed by endoscopy. We describe a case of jejunal diffuse large B-cell lymphoma which was initially read as jejunal diverticulitis on imaging. CASE DESCRIPTION/METHODS: Our patient is a 60-year-old male with poorly controlled diabetes, hypertension, hyperlipidemia, and COPD who presented with abdominal pain, nausea, and vomiting. Abdominal pain was dull in nature, located around the umbilical area, and had been going on for about a month. He had made multiple emergency department visits for similar symptoms in the prior weeks. Also, he lost about 20 pounds of weight and had decreased appetite over the last 3 months. CT scan of the abdomen showed inflammatory changes surrounding the proximal jejunum (Image 1) characterized as jejunal diverticulitis. He was given antibiotics without any improvement in symptoms. Eventually, a push enteroscopy was performed which showed a partially obstructing mass just distal to the duodenojejunal junction (Image 2). Tattoos were placed proximally and distally for marking. Biopsy was diagnostic of diffuse large B-cell lymphoma. PET scan was performed which showed localized disease with adjacent lymph node involvement. Patient underwent surgical resection of the tumor due to concern of bowel perforation followed by chemotherapy. DISCUSSION: Tumors in the small bowel are exceedingly rare and can easily be overlooked as their presenting symptoms are bizarre and non-specific. The most common symptoms are pain, obstruction, and bleeding while perforation can rarely occur as well. Abdominal imaging is usually the first line modality to figure out the etiology of these symptoms. Imaging usually shows some abnormalities in these cases but is not confirmatory and at times may lead to other diagnoses as was the case in our patient. Patient’s history should be considered when figuring out the diagnosis in these cases. If there are any alarming symptoms such as weight loss, decreased appetite, or no improvement after initial treatment then there should be a high index of suspicion for small bowel tumors and endoscopy should be performed as early detection is the most important prognostic factor in these cases.Figure 1.: Inflammatory changes around the jejunal area read as jejunal diverticulitis.Figure 2.: Partially obstructing mass seen on enteroscopy distal to duodenojejunal junction.

Small Bowel Neoplasms: A Pictorial Review.

Small bowel tumors are rare and account for approximately 3% of all gastrointestinal tumors in the United States. The incidence of small bowel neoplasms is rising-in particular, there is a rising incidence of small bowel carcinoid tumors. This may in part be due to small bowel lesion identification in an increasing number of cross-sectional imaging studies performed for other indications as well as increased use of advanced imaging techniques to assess specifically for small bowel disease. Diagnosis is a challenge owing to nonspecific clinical manifestation, rare occurrence, and low index of clinical suspicion. Yet, various small bowel neoplasms have characteristic imaging features at CT and MRI when optimal distention of the small bowel is achieved, correlating well with features seen in gross specimens. Understanding the imaging features of small bowel neoplasms is important to improve the radiologist's ability to diagnose and characterize small bowel neoplasms. Most small bowel tumors are clinically silent for long periods, and nearly half of the benign tumors are found incidentally during surgery or at cross-sectional imaging performed for other reasons. The authors review the imaging features of common benign and malignant small bowel neoplasms to aid the radiologist in diagnosis of small bowel tumors. ©RSNA, 2020.

1902 Small Bowel Tumor: The Answer to Unexplained Overt Gastrointestinal Bleeding

INTRODUCTION: The rarity of small bowel tumors often makes diagnosis difficult due to nonspecific and variable presenting symptoms. This can result in a delay of diagnosis and consequent poor treatment outcome. Small bowel tumors can be either malignant (adenocarcinomas, lymphomas, sarcomas, and neuroendocrine tumors) or benign (adenomas, leiomyomas, and lipomas). CASE DESCRIPTION/METHODS: We present the case of a 58-year-old male, who presented to the hospital with dizziness, lightheadedness, and dyspnea on exertion for 3 days. History was significant for GERD, and iron deficiency anemia. Recent outpatient evaluation of weakness and fatigue revealed hemoglobin of 10 g/dL, decreased from 16.3 g/dL one year prior. An outpatient colonoscopy was scheduled for the following month but presented to the hospital because of multiple episodes of melenic stools. He denied any hematochezia, abdominal pain, weight loss, dysphagia, nausea, vomiting or hematemesis. He denied any family or personal history of malignancy or inflammatory bowel disease. He was tachycardic on examination. Initial lab work revealed hemoglobin of 8.2 g/dL. During his hospitalization, the patient experienced frank hematochezia and required transfusion of several units of blood due to acute blood loss. The patient underwent endoscopic evaluation, which revealed a small hiatal hernia with normal stomach and normal examined duodenum. A colonoscopy revealed red blood in the entire examined colon as well as the distal ileum. The patient then underwent video capsule endoscopy (VCE), which localized a source of bleeding in the proximal jejunum. A subsequent small bowel enteroscopy revealed a large infiltrative, polypoid, submucosal and ulcerated mass in the proximal jejunum. A CT scan revealed the location of the mass. The patient ultimately went to the operating room. Intraoperative visualization noted the mass to be exophytic, approximately 5 cm in diameter with mild purulence into the peritoneal cavity but without evidence of carcinomatosis. DISCUSSION: Adequate diagnosis of small bowel tumors, which present with varied and nonspecific symptoms, can inform early and appropriate treatment. In this case, endoscopic evaluation with EGD, colonoscopy, and VCE, resulted in the localization of the tumor and facilitated its surgical excision. This case exemplifies a practical algorithmic approach to the evaluation of an unexplained overt gastrointestinal bleed in a patient with nonspecific symptoms.

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

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.

Comparison of multi-modality MR enterography and CT enterography in the diagnosis of small bowel tumor

Comparison of multi-modality MR enterography and CT enterography in the diagnosis of small bowel tumor

Formulation and statistical evaluation of an automated algorithm for locating small bowel tumours in wireless capsule endoscopy

Wireless capsule endoscopy (WCE) is an imaging modality which is highly reliable in the diagnosis of small bowel tumors. But locating the frames carrying tumors manually from the lengthy WCE is cumbersome and time consuming. A simple algorithm for the automated detection of tumorous frames from WCE is proposed in this work. In the proposed algorithm, local binary pattern (LBP) of the contrast enhanced green channel is used as the textural descriptor of the WCE frames. The features employed to differentiate tumorous and non-tumorous frames are skewness (S) and kurtosis (K) of the LBP histogram. The threshold value of the features which offers the trade-off between sensitivity and specificity is identified through Receiver Operating Characteristic (ROC) curve analysis. At the optimum threshold, both the features exhibited a sensitivity of 100% and specificity of 90%. The skewness and kurtosis of the LBP computed from the enhanced green channel of tumorous and non-tumorous frames differ significantly (p « 0.05) with a p-value of 2.2 × 10−16. The proposed method is helpful to reduce the time spent by the doctors for reviewing WCE.

P.06.16: The Role of Wireless Capsule Endoscopy in the Diagnosis of Small Bowel Tumors: A Single Centre Experience

P.06.16: The Role of Wireless Capsule Endoscopy in the Diagnosis of Small Bowel Tumors: A Single Centre Experience

Characterization of Endoscopic Findings of Small Bowel Tumors and Clinical Usefulness of Double-Balloon Endoscopy

Introduction: While 35 cases of small bowel tumor have been diagnosed since introduction of double balloon endoscopy (DBE) in our hospital, most cases of the disease were diagnosed at advanced stage with remarkable ulcerous lesion. To characterize endoscopic findings, we retrospectively analyzed endoscopic images of small bowel tumor cases diagnosed in our hospital. Methods: Based on the medical records, we retrospectively analyzed endoscopic images and patients' characteristics of 35 small bowel tumor cases diagnosed at Kyorin University hospital from 2005 to 2014. Results: In 35 cases, male-to-female ratio was 17:18 and mean age was 65.4 years. The reason for taking DBE was 21 of gastrointestinal bleeding of obscure origin (OGIB), 5 of ileus, 5 of tumorous lesions detected by other modalities, 2 of vomiting, and 2 of others. In the cases of OGIB, 15 cases were malignant tumors, and all of them were advanced stage. There was none of malignant tumor at earlier stage. Final diagnosis of 25 small bowel tumor cases were malignant tumors including 9 of GIST, 7 of adenocarcinoma, 4 of malignant lymphoma, 3 of metastatic small intestinal cancer, 2 of neuroendocrine tumor (NET). Other 10 cases were benign tumors. In the endoscopic images, submucosal tumor-like ridges with redness were observed in all 9 GIST cases including 6 cases with ulcer. All of the 7 adenocarcinoma cases were found as protruded lesions with ulcers. Irregular protruded lesions with ulcers were observed in all 4 malignant lymphoma cases. In a NET case, a protruded lesion with narrow-shaped ulcer was observed. As described above, ulcerous lesions with deep and wide range were concurrently observed in 22 of 35 small-bowel tumor cases, particularly, in malignant lymphoma, adenoma, and metastatic small-bowel tumor. About safety of DBE, perforation as complication was occurred only in a case of metastatic small bowel tumor. Conclusion: Although the majority of reason for DBE was OGIB, many cases were found at advanced stage in malignant cases. These lesions were often appeared as tumor with a wide range of ulcerous lesions. DBE is useful for pathological diagnosis of small bowel tumors, but further improvement is necessary for diagnosis of malignant tumor at earlier stage.

Guidelines for video capsule endoscopy: emphasis on Crohn's disease.

Video capsule endoscopy (VCE) is an ingestible video camera that transmits high-quality images of the small intestinal mucosa. This makes the small intestine more readily accessible to physicians investigating the presence of small bowel disorders, such as Crohn's disease (CD). Although VCE is frequently performed in Korea, there are no evidence-based guidelines on the appropriate use of VCE in the diagnosis of CD. To provide accurate information and suggest correct testing approaches for small bowel diseases, the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy, developed guidelines on VCE. Teams were set up to develop guidelines on VCE. Four areas were selected: diagnosis of obscure gastrointestinal bleeding, small bowel preparation for VCE, diagnosis of CD, and diagnosis of small bowel tumors. Three key questions were selected regarding the role of VCE in CD. In preparing these guidelines, a systematic literature search, evaluation, selection, and meta-analysis were performed. After writing a draft of the guidelines, the opinions of various experts were solicited before producing the final document. These guidelines are expected to play a role in the diagnosis of CD. They will need to be updated as new data and evidence become available.

Small bowel masses

The diagnosis of small-bowel tumours, particularly early detection and differential diagnosis, is still somewhat challenging, although many sensitive direct and indirect techniques have been adopted. Although spatial resolution of MR imaging is lower than that of a CT scan, the main advantages of the former are the combination of good soft-tissue contrast, detection of extraenteric abnormalities, and lack of radiation exposure, which allows repeated data acquisition for functional bowel evaluation. Enteroclysis provides greater distention of the entire small bowel than does enterography in patients suspected of having small-bowel neoplasms, because small polypoid masses that do not produce obstruction are most likely difficult to detect by using oral contrast material distention. Moreover, MR enteroclysis delineates superficial changes more accurately than does MR enterography and the evaluation of endoluminal abnormalities is particularly important in the detection of early-stage small-bowel neoplasms. MR enteroclysis has yielded a 96.6% accuracy in the detection of small-bowel neoplasms, thereby proving to be an effective means of diagnosing or ruling out small-bowel neoplasms. MR enterography is an accurate, well-tolerated, promising imaging modality with which to diagnose or exclude small-bowel tumours in symptomatic patients with negative upper and lower endoscopy findings. MR enterography might allow clinicians to select patients in whom more invasive diagnostic methods are indicated. MR enterography, which allows improved localization of small-bowel polyps in patients with Peutz- Jeghers syndrome, is performed to identify larger lesions that should be resected at double-balloon enteroscopy or surgery. It may also be helpful for excluding the presence of lesions in bowel segments not examined at endoscopy or surgery. MRI has proved to be more sensitive than CT for the detection of endoluminal esions of the small bowel, owing to improved detection of segments with subtle abnormalities. These findings may be due both to the better soft-tissue contrast afforded by MR imaging, which is required for tissue characterization and the detection of subtle areas of abnormality, and to its functional capabilities. Another advantage of MR imaging over CT is that the enhanced soft-tissue contrast produced by MR imaging may provide more information regarding the nature of mesenteric small bowel tumors, thereby allowing better characterization of small-bowel tumors. In this regard, benign tumors such as hemangiomas are typically strongly hyperintense on T2-weighted MR images, whereas lipomas or tumors with a marked fat content are spontaneously hyperintense on T1-weighted MR images. With few exceptions (lymphoma being one), thickening of a long segment of the small bowel is indicative of a benign condition. MR enteroclysis and enterography are accurate non-invasive modalities in assessing the intraluminal, parietal and extraluminal neoplastic manifestations. MR signal appearances of the lesions, combined with the contrast enhancement behaviour and the characteristic of the stenosis, can help in differentiating from other non-neoplastic diseases of the small-bowel. Radiologists should therefore be familiar with the MR appearance of various small-bowel neoplasms and their mimickers.

PTH-142 Does Double Balloon Enteroscopy Affect Management In Patients With Suspected Small Bowel Tumours? Experience From A Single Tertiary Centre

IntroductionThe advent of small bowel capsule endoscopy (CE) has greatly improved the diagnosis of small bowel tumours. Double balloon enteroscopy (DBE) is the interventional counterpart to CE and has the...

Capsule endoscopy for diagnosis of small bowel tumors: a single-center experience with 21 consecutive patients

Objective To evaluate the diagnostic and therapeutic values of capsule endoscopy(CE)for small bowel tumors(SBTs).Methods Totally 773patients with suspected SBTs disease underwent CE during October,2006to December,2011.Further examination was done for patients with suspected SBTs,and the final diagnosis was made by CE and pathological confirmation.Results SBTs were detected in 21patients(14males,and 7females,mean age[53.9±15.7]years),with a detection rate of 2.7%.Nineteen patients had obscure gastrointestinal bleeding and two had abdominal pain.Four events of capsule retention occurred at the lesion sites.Nineteen patients underwent surgical treatment and two received chemotherapy;the patients were followed up for a mean of(19±14)(range 5-32)months;and there were two death cases due to metastasis(one at 5months of follow-up and the other at 17months).Conclusion CE is an effective choice for diagnosis of suspected SBTs,which is of guidance value for the treatment and prognosis of SBTs.

Su1275 Preoperative Diagnosis of Small Bowel Tumors by Double Balloon Enteroscopy; A Single-Center Experience

Su1275 Preoperative Diagnosis of Small Bowel Tumors by Double Balloon Enteroscopy; A Single-Center Experience

Clinical value of spiral CT in diagnosis of small bowel tumors

Objective To explore the clinical vaue of multilayer spiral CT in diagnosis of small intestinal tumor.Methods 36 cases with small intestinal tumor were selected as the research objects,the multi-slice spiral CT imaging results were analyzed retrospectively.Results Sensitivity of multi-slice spiral CT was 94.4％,accuracy of 88.9％.Conclusion Spiral CT is a safe,simple,non-invasive,effective method in diagnosis of small bowel tumors,it has high detection rate. Key words: Tomography,X-ray computed; Ileal neoplasms; Jejunal neoplasms; Diagnosis

Small bowel tumors: spectrum of findings on 64-section CT enteroclysis with pathologic correlation

Improvements in helical technology have made detection of benign and malignant small bowel tumors easier so that they are now frequently detected at an early stage. Sixty-four-section CT enteroclysis provides suggestive features that help determine the actual nature of a small bowel tumor in a large number of cases. Specific diagnosis of small bowel tumor is based on a combination of findings that are depicted owing to the use of the multiple capabilities of 64-section CT enteroclysis, allowing optimal planning prior to endoscopic or surgical resection.

Clinical Characteristics of Small Bowel Tumors Diagnosed by Double-Balloon Endoscopy: KASID Multi-Center Study

Small bowel tumors are relatively rare, and their confirmative diagnosis before surgery is not easy. This study was performed to investigate the clinical characteristics of patients with small bowel tumors who received double-balloon enteroscopy (DBE). Secondary end points were to evaluate the usefulness and safety of DBE for the diagnosis of patients with suspected SB tumors derived from other previous procedures. We retrospectively analyzed consecutive DBE examinations to explore the small intestine in eight university hospitals over a 5-year period. A total of 877 DBE examinations (per oral 487, per anal 390) were performed in 645 patients (405 males, mean age 48.2years). Small bowel tumors were diagnosed in 112 patients (17.4%), of which 38 patients had benign polyps, 29 had gastrointestinal stromal tumors/leiomyomata, 18 had lymphomas, 14 had adenocarcinomas, five had metastatic or invasive cancers, five had lipomas, and three patients had cystic tumors. The main reasons for DBE among patients with small bowel tumors were obscure gastrointestinal bleeding (OGIB, 40.2%) followed by abnormal imaging study (25.2%). The concordance rate of diagnoses based on DBE with diagnoses based on small bowel follow-through, CT, and capsule endoscopy among patients with small bowel tumors was 68.9% (42/61), 75.3% (70/93), and 78.3% (18/23), respectively. Therapeutic plans were changed due to the DBE results in 64.2% of patients with small bowel tumors. Approximately one-sixth of patients who received DBE had small bowel tumors, and the most common reason for DBE among patients with small bowel tumors was OGIB. DBE is a useful method for the confirmative diagnosis of small bowel tumors and has a good clinical impact on therapeutic plans and short-term clinical results.

The Use of Capsule Endoscopy for the Investigation of Small Bowel Tumors: Experience from a United Kingdom Single Center

We read with interest the article by Imaoka et al. [1] on the use of double-balloon enteroscopy (DBE) for the diagnosis of small bowel tumors. We would like to share our observations on using capsule endoscopy (CE) for the diagnosis of small bowel neoplasms. We conducted a study to evaluate the clinical presentation, endoscopic appearance, diagnostic and therapeutic impact of CE in the management of small bowel tumors. A retrospective review of consecutive patients that underwent CE with the findings of small bowel tumors over a 7-year period was conducted. Data was collected for patient demographics, indication of CE, findings on CE including location of suspected tumor with subsequent follow-up data. Twenty-four patients were found to have a small bowel tumor on CE. This represented 1.5% of all patients that underwent CE over the 7-year period. The indications included iron deficiency anemia (n = 9), overt bleeding (n = 11), and investigation of complications of celiac disease (n = 4). Patients had a mean number of 4.7 tests prior to CE, which included gastroscopy, colonoscopy, small bowel radiology, computed tomographic scanning, mesenteric angiograms and red cell labeled scans. The mean age in the group was 55 years (range 34–83 years), which is similar to that reported by Trifan et al. [2] but lower than that reported by Imaoka et al. [1] in a Japanese population. The endoscopic appearances on CE included a mass or ulcerated mass lesion (n = 20) or isolated ulceration of mucosa with fresh bleeding (n = 3) and multiple ulcers with abnormal underlying mucosa (n = 1). The tumors were located in the jejunum in ten patients, in the ileum in 13 patients, and in the fourth part of the duodenum in one patient. The lesions were single in 96% of cases and multiple in 4% (n = 1). Capsule retention occurred in four patients (16.6%). Nineteen patients underwent surgery whilst 2 patients were treated with chemotherapy. The tumors were adenocarcinoma (n = 4), carcinoid (n = 2), gastrointestinal stromal tumor (GIST, n = 5), lymphoma (n = 4), vascular tumors (hemangioma, angioma, angiomyolipoma, n = 6), metastatic renal cancer (n = 1), glomus tumor (n = 1) and a benign fibroid tumor (n = 1). Three patients were treated palliatively. CE like DBE is an important modality in the diagnostic work up of patients with small bowel tumors and it has a positive impact on patient management. The early use of CE in these patients should be encouraged as it often detects tumors missed by conventional modalities [3]. While CE is a non-invasive modality, it does not have the ability to obtain biopsies, hence both CE and DBE should be used complementary to each other for the diagnosis of small bowel tumors.