Abstract
Background
Capsule endoscopy has involved a significant advance in techniques for imaging of the small bowel. Its most frequent indication is for studying patients with obscure gastrointestinal bleeding (OGIB). Small bowel tumors are infrequent, representing only 1% to 3% of all malignant gastrointestinal tumors. This study aimed to assess retrospectively the occurrence and characteristics of tumoral pathology diagnosed by means of capsule endoscopy in patients with OGIB.
Methods
A retrospective review analyzed the first 320 patients submitted to capsule endoscopy because of OGIB (166 with obscure overt bleeding and 154 with obscure occult bleeding) at a single center. The patients with a tumor diagnosis were analyzed in terms of incidence, characteristics, and treatment of OGIB pathology.
Results
Tumor incidence was of 7.18% (23/320), with 65.2% of the cases supported with histologic confirmation (15/23). Obscure overt bleeding was the most frequent form of presentation, with the jejunum as the most frequent location (65.2%). For 16 patients, an intervention was conducted with a healing intent. Capsule endoscopy allowed the diagnosis of two cecal adenocarcinomas missed by colonoscopy.
Conclusions
Small bowel tumors are not an infrequent cause of OGIB. Capsule endoscopy, even if it does not allow determination of the benign or malignant nature or the histologic type of the tumor, is a useful tool for the diagnosis and early management of these tumors.
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References
Ashley SW, Wells SA Jr (1988) Tumors of the small intestine (review). Semin Oncol 15: 116–128
Brophy C, Cahow CE (1989) Primary small bowel malignant tumors: unrecognized until emergent laparotomy. Am Surg 55: 408–412
Crosby JA, Catton CN, Davis A, Couture J, O’Sullivan B, Kandel R, Swallow CJ (2001) Malignant gastrointestinal stromal tumors of the small intestine: a review of 50 cases from a prospective database. Ann Surg Oncol 8: 50–59
Dabaja BS, Suki D, Pro B, Bonnen M, Ajani J (2004) Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer 101: 518–526
Desa L, Bridger J, Grace P, Krausz T, Spencer J (1991) Primary jejunoileal tumors: a review of 45 cases. World J Surg 15: 81–87
DiSario JA, Burt RW, Vargas H, Mc Whorter WP (1994) Small bowel cancer: epidemiological and clinical characteristics from a population-based registry. Am J Gastroenterol 89: 699–701
Ell C, Remke S, May A, Helou L, Henrich R, Mayer G (2002) The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 34: 685–689
Kituyakara T, Selby W (2005) Non–small bowel lesions detected by capsule endoscopy in patients with obscure GI bleeding. Gastrointest Endosc 62: 234–238
Lewis BS, Eisen GM, Friedman S (2005) A pooled analysis to evaluate results of capsule endoscopy trials. Endoscopy 37: 960–965
Maieron A, Hubner D, Blaha B, Deutsch C, Schickmair T, Ziachehabi A, Kerstan E, Knoflach P, Schoefl R (2004) Multicenter retrospective evaluation of capsule endoscopy in clinical routine. Endoscopy 36: 864–868
Pennazio M, Santucci R, Rondonotti E, Abbiati C, Beccari G, Rossini FP, De Franchis R (2004) Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 126: 643–653
Saurin JC, Delvaux M, Gaudin JL, Fassler I, Villarejo J, Vahedi K, Bitoun A, Canard JM, Souquet JC, Ponchon T, Florent C, Gay G (2003) Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push enteroscopy. Endoscopy 35: 576–584
Selby W (2004) Can clinical features predict the likelihood of finding abnormalities when using capsule endoscopy in patients with GI bleeding of obscure origin? Gastrointest Endosc 59: 782–787
Serour F, Dona G, Birkenfeld S, Balassiano M, Krispin M (1992) Primary neoplasms of the small bowel. J Surg Oncol 49: 29–34
Talamonti MS, Goetz LH, Rao S, Joel RJ (2002) Primary cancers of the small bowel. Arch Surg 137: 564–571
Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK, Heigh RI, Shiff AD, Sharma VK (2005) A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 100: 2407–2418
Viazis N, Papaxoinis K, Theodoropoulus I, Sgouros S, Vlachogiannakos J, Pipis P, Markoglou C, Avgerinos A (2005) Impact of capsule endoscopy in obscure small-bowel bleeding: defining strict criteria for a favorable outcome. Gastrointest Endosc 62: 717–722
Zuckerman GR, Prakash C, Askin MP, Lewis BS (2000) AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 118: 201–221
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Estévez, E., González-Conde, B., Vázquez-Iglesias, J.L. et al. Incidence of tumoral pathology according to study using capsule endoscopy for patients with obscure gastrointestinal bleeding. Surg Endosc 21, 1776–1780 (2007). https://doi.org/10.1007/s00464-007-9242-8
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DOI: https://doi.org/10.1007/s00464-007-9242-8