Digestive Diseases and Sciences

, Volume 54, Issue 5, pp 1050–1058

Detection of Neuroendocrine Tumors of the Small Bowel by Double Balloon Enteroscopy

  • Michael Bellutti
  • Lucia C. Fry
  • Johannes Schmitt
  • Marcus Seemann
  • Silke Klose
  • Peter Malfertheiner
  • Klaus Mönkemüller
Original Article

Abstract

Background Neuroendocrine tumors (NET) account for one-third of all small bowel neoplasms. The search for the primary tumor in NET is important, even though it is difficult to localize, as its surgical excision leads to a better prognosis, even in metastasized stages of the disease. The objective of this study was to evaluate the use of double balloon enteroscopy (DBE) for the detection of the primary tumor in patients with NET. Methods Twelve consecutive patients (eight women, four men) with suspected carcinoid syndrome, either metastatic to the liver (n = 5), symptoms of a neuroendocrine tumor with elevated tumor markers (n = 5), or obscure gastrointestinal bleeding (n = 2) underwent DBE for the search of the primary tumor or the source of bleeding. All patients underwent abdominal sonography and a computed tomography (CT) scan, esophagogastroduodenoscopy (EGD), ileocolonoscopy, and octreotide scintigraphy prior to DBE. Capsule endoscopy was performed in four patients. Results A total of 17 DBE were performed in the 12 patients. The CT scan and sonography of the abdomen as well as EGD and ileocolonoscopy were unable to detect the primary tumor in any patient. A submucosal tumor of the ileum or the jejunum could be detected by DBE was detected in seven patients (58%) (anal route, n = 4; oral route, n = 3). In four of these patients (33%) this finding could be confirmed by the surgical resection of a NET. In two patients (17%) with a submucosal ileum protrusion suspicious for NET, laparotomy and intraoperative endoscopy did not confirm the tumor. Conclusions In this study, the diagnostic yield of DBE for primary tumor search in patients with metastatic or suspected NET was 33%. Although endoscopic small bowel investigation by DBE seems to enrich the diagnostic possibilities for the diagnosis of small bowel-NET, at the present time DBE should only be performed in selected cases, possibly based on a positive previous work-up.

Keywords

Double balloon enteroscopy Intestinal disorders Neuroendocrine tumors Small bowel 

References

  1. 1.
    Plöckinger U, Rindi G, Arnold R, et al Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours. A consensus statement on behalf of the European Neuroendocrine Tumour Society (ENETS). Neuroendocrinology. 2004;80:394–424.PubMedCrossRefGoogle Scholar
  2. 2.
    Kulke MH, Mayer RJ. Carcinoid tumors. N Engl J Med. 1999;340:858–868. doi:10.1056/NEJM199903183401107.PubMedCrossRefGoogle Scholar
  3. 3.
    Modlin IM, Latich I, Zikusoka M, Kidd M, Eick G, Chan AK. Gastrointestinal carcinoids: the evolution of diagnostic strategies. J Clin Gastroenterol. 2006;40:572–582. doi:10.1097/00004836-200608000-00003.PubMedCrossRefGoogle Scholar
  4. 4.
    Kerström G, Hellman P, Hessman O. Midgut carcinoid tumours: surgical treatment and prognosis. Best Pract Res Clin Gastroenterol. 2005;19:717–728. doi:10.1016/j.bpg.2005.05.005.PubMedCrossRefGoogle Scholar
  5. 5.
    Boudreaux JP, Putty B, Frey DJ, et al Surgical treatment of advanced-stage carcinoid tumors: lessons learned. Ann Surg. 2005;241:839–845. doi:10.1097/01.sla.0000164073.08093.5d.PubMedCrossRefGoogle Scholar
  6. 6.
    Kaltsas G, Rockall A, Papadogias D, Reznek R, Grossman AB. Recent advances in radiological and radionuclide imaging and therapy of neuroendocrine tumours. Eur J Endocrinol. 2004;151:15–27. doi:10.1530/eje.0.1510015.PubMedCrossRefGoogle Scholar
  7. 7.
    Nikou GC, Lygidakis NJ, Toubanakis C, et al Current diagnosis and treatment of gastrointestinal carcinoids in a series of 101 patients: the significance of serum chromogranin-A, somatostatin receptor scintigraphy and somatostatin analogues. Hepatogastroenterology. 2005;52:731–741.PubMedGoogle Scholar
  8. 8.
    Johanssen S, Boivin M, Lochs H, Voderholzer W. The yield of wireless capsule endoscopy in the detection of neuroendocrine tumors in comparison with CT enteroclysis. Gastrointest Endosc. 2006;63:660–665.PubMedCrossRefGoogle Scholar
  9. 9.
    van Tuyl SA, van Noorden JT, Timmer R, Stolk MF, Kuipers EJ, Taal BG. Detection of small-bowel neuroendocrine tumors by video capsule endoscopy. Gastrointest Endosc. 2006;64:66–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Yamamoto H, Yano T, Kita H, Sunada K, Ido K, Sugano K. New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. Gastroenterology. 2003;125:1556–1557.PubMedCrossRefGoogle Scholar
  11. 11.
    Heine GD, Hadithi M, Groenen MJ, Kuipers EJ, Jacobs MA, Mulder CJ. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy. 2006;38:42–48.PubMedCrossRefGoogle Scholar
  12. 12.
    Mönkemüller K, Weigt J, Treiber G, et al Diagnostic and therapeutic impact of double-balloon enteroscopy. Endoscopy. 2006;38:67–72.PubMedCrossRefGoogle Scholar
  13. 13.
    May A, Nachbar L, Wardak A, Yamamoto H, Ell C. Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain. Endoscopy. 2003;35:985–991.PubMedCrossRefGoogle Scholar
  14. 14.
    Yamaguchi T, Manabe N, Tanaka S, et al Multiple carcinoid tumors of the ileum preoperatively diagnosed by enteroscopy with the double balloon technique. Gastrointest Endosc. 2005;62:315–318.PubMedCrossRefGoogle Scholar
  15. 15.
    Mehdizadeh S, Ross A, Gerson L, et al What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. Gastrointest Endosc. 2006;64:740–750.PubMedCrossRefGoogle Scholar
  16. 16.
    Horton KM, Kamel I, Hofmann L, Fishman EK. Carcinoid tumors of the small bowel: a multitechnique imaging approach. Am J Roentgenol. 2004;182:559–567.Google Scholar
  17. 17.
    Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD. Current status of gastrointestinal carcinoids. Gastroenterology. 2005;128:1717–1751.PubMedCrossRefGoogle Scholar
  18. 18.
    Mehdizadeh S, Han NJ, Cheng DW, Chen GC, Lo SK. Success rate of retrograde double-balloon enteroscopy. Gastrointest Endosc. 2007;65:633–639.PubMedCrossRefGoogle Scholar
  19. 19.
    Matsumoto T, Esaki M, Moriyama T, Nakamura S, Iida M. Comparison of capsule endoscopy and enteroscopy with the double-balloon method in patients with obscure bleeding and polyposis. Endoscopy. 2005;37:827–832.PubMedCrossRefGoogle Scholar
  20. 20.
    Su MY, Liu NJ, Hsu CM, Chiu CT, Chen PC, Lin CJ. Double balloon enteroscopy—the last blind-point of the gastrointestinal tract. Dig Dis Sci. 2005;50:1041–1045.PubMedCrossRefGoogle Scholar
  21. 21.
    Ricke J, Klose KJ, Mignon M, Oberg K, Wiedenmann B. Standardisation of imaging in neuroendocrine tumours: results of a European delphi process. Eur J Radiol. 2001;37:8–17.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Michael Bellutti
    • 1
  • Lucia C. Fry
    • 1
  • Johannes Schmitt
    • 2
  • Marcus Seemann
    • 3
  • Silke Klose
    • 4
  • Peter Malfertheiner
    • 1
  • Klaus Mönkemüller
    • 1
  1. 1.Department of Gastroenterology, Hepatology and Infectious Diseases, UniversitätsklinikumOtto-von-Guericke UniversityMagdeburgGermany
  2. 2.Institute of Pathology, UniversitätsklinikumOtto-von-Guericke-UniversityMagdeburgGermany
  3. 3.Department of Radiology and Nuclear Medicine, UniversitätsklinikumOtto-von-Guericke-UniversityMagdeburgGermany
  4. 4.Department of Endocrinology and Metabolism, UniversitätsklinikumOtto-von-Guericke-UniversityMagdeburgGermany

Personalised recommendations