Management Of Small Bowel Tumors Research Articles

The Role of Capsule Endoscopy in the Diagnosis and Management of Small Bowel Tumors: A Narrative Review.

Small bowel tumors (SBT) are relatively rare, but have had a steadily increasing incidence in the last few decades. Small bowel capsule endoscopy (SBCE) and device-assisted enteroscopy are the main endoscopic techniques for the study of the small bowel, the latter additionally providing sampling and therapeutic options, and hence acting complementary to SBCE in the diagnostic work-up. Although a single diagnostic modality is often insufficient in the setting of SBTs, SBCE is a fundamental tool to drive further management towards a definitive diagnosis. The aim of this paper is to provide a concise narrative review of the role of SBCE in the diagnosis and management of SBTs.

Impact of enteroscopy on diagnosis and management of small bowel tumors

Small bowel tumors (SBTs) have been increasingly diagnosed in recent decades. The pathogenesis of this increment is largely unknown, but advances in radiological and endoscopic methods facilitate the improvement of the diagnosis. Capsule endoscopy (CE) and device-assisted enteroscopy (DAE) allow the clinician to assess the entire small bowel in the search for suspicious lesions, or a cause of symptoms. In this review, we discuss the role of enteroscopy, techniques and strategies in the diagnosis and management of SBTs, and a brief description of the most common tumors.

Small Bowel Tumors Discovered During Double-Balloon Enteroscopy

The emergence of capsule endoscopy and double-balloon enteroscopy (DBE) has greatly enhanced the management of small bowel tumors (SBTs). DBE is particularly useful as a diagnostic modality because it allows for direct investigation of the gastrointestinal lumen, yet little data exist regarding its clinical efficacy. : To determine the diagnostic yield of DBE in detection of SBTs. We restrospectively reviewed our large prospectively collected DBE database from September 2005 to May 2012. Patients who were diagnosed with SBTs by DBE were included in the study. The diagnostic yield of DBE in detection of SBTs was calculated by frequency analysis. A total of 1106 patients underwent 1652 DBE procedures. Of these patients, 134 (12.1%) were found to have an SBT. The majority (56.7%) of patients diagnosed with SBT were male, and the average age at the time of diagnosis was 64 years (SD±14 y). Indications for performing DBE included suspected mass lesion in 54.5% (73/134) of SBT patients, obscure gastrointestinal bleeding in 26.9% (36/134), and overt gastrointestinal bleeding in 14.9% (20/134). The most common SBTs identified were: carcinoid (26/134, 19.4%), hamartoma (14/134, 10.4%), inflammatory polyp (11/134, 8.2%), gastrointestinal stromal tumor (10/134, 7.5%), and lymphoma (10/134, 7.5%). DBE is a valuable tool in the evaluation of SBTs. The incidence of SBTs in our patient population was significantly higher than the generally accepted incidence for the overall population, but was comparable with other similar studies. Carcinoid tumor was the most common SBT identified, and was most often seen in the ileum.

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.

Small Bowel Tumors

Although rare, small bowel tumors may cause significant morbidity and mortality if left undetected. New endoscopic modalities allow full examination of the small bowel with improved diagnosis. However, isolated mass lesions may be missed by capsule endoscopy or incomplete balloon-assisted enteroscopy. Therefore the use of radiologic imaging and intraoperative enteroscopy for diagnosis should not be forgotten. Endoscopic resection of small bowel polyps and certain vascular tumors is possible but requires proper training. Advances in endoscopic tools are likely to broaden the endoscopic management of small bowel tumors. This article describes the general features of small bowel tumors, clinical presentation, and diagnostic tests followed by a description of the more common tumor types and their management.

Capsule endoscopy in neoplastic diseases

Until recently, diagnosis and management of small-bowel tumors were delayed by the difficulty of access to the small bowel and the poor diagnostic capabilities of the available diagnostic techniques. An array of new methods has recently been developed, increasing the possibility of detecting these tumors at an earlier stage. Capsule endoscopy (CE) appears to be an ideal tool to recognize the presence of neoplastic lesions along this organ, since it is non-invasive and enables the entire small bowel to be visualized. High-quality images of the small-bowel mucosa may be captured and small and flat lesions recognized, without exposure to radiation. Recent studies on a large population of patients undergoing CE have reported small-bowel tumor frequency only slightly above that reported in previous surgical series (range, 1.6%-2.4%) and have also confirmed that the main clinical indication to CE in patients with small-bowel tumors is obscure gastrointestinal (GI) bleeding. The majority of tumors identified by CE are malignant; many were unsuspected and not found by other methods. However, it remains difficult to identify pathology and tumor type based on the lesion's endoscopic appearance. Despite its limitations, CE provides crucial information leading in most cases to changes in subsequent patient management. Whether the use of CE in combination with other new diagnostic (MRI or multidetector CT enterography) and therapeutic (Push-and-pull enteroscopy) techniques will lead to earlier diagnosis and treatment of these neoplasms, ultimately resulting in a survival advantage and in cost savings, remains to be determined through carefully-designed studies.

Small bowel tumors: an overview.

Tumors of the small bowel, both benign and malignant, are relatively uncommon and often present a diagnostic challenge as their symptoms are often vague. This review article outlines the incidence, presentation, diagnosis, and management of small bowel tumors.