Sporadic small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding

Abstract

Intestinal tumors represent less than 6 % of digestive tumors, and, because of the limitations of intestinal investigations, these tumors are difficult to diagnose. In this context, capsule endoscopy has proven effective, especially in patients with obscure digestive bleeding. In a large series of patients undergoing capsule endoscopy, small bowel tumors are found in 2.4–8.9 % of cases. The aim of this retrospective, single-center study, based on prospective database, is to evaluate the frequency of small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding. During 2004–2014, 849 consecutive patients underwent CE at our Department for occult gastrointestinal bleeding. Following capsule endoscopy, the medical records of the study population were reviewed. Results of double-balloon enteroscopy or surgery performed after capsule endoscopy were retrieved. Capsule endoscopy identified 55 small bowel tumors (6.5 %), of which 28 malignancies (51 %) and 27 benign neoplasms (49 %) underwent surgery or endoscopic treatment. Malignancies included adenocarcinoma (18.7 %), gastrointestinal stromal tumors (GIST) (12 %) and lymphoma (6.7 %). Benign neoplasms included dysplastic adenomatous polyps (36 %) and hyperplastic polyps (25.3 %). Non-neoplastic masses included one inflammatory polyp. Capsule retention occurred in four patients (5.3 %) and the retained capsule was retrieved during surgery. In our experience neoplasms of small bowel are found in 6.5 % of patients with occult gastrointestinal bleeding. Of these malignancies, small bowel neoplasms are found in 3.3 % of cases. Capsule endoscopy is an effective and sensitive diagnostic tool, and plays an important role in the algorithm for the diagnostic workup of suspected small bowel tumors.