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Small-Bowel Tumors, Polyps, and Polyposis Syndromes

  • Alessandra Bizzotto
  • Maria Elena RiccioniEmail author
  • Rosario Landi
  • Clelia Marmo
  • Brunella Barbaro
  • Guido Costamagna

Abstract

Despite the fact that the small bowel accounts for the majority of the length of the alimentary tract, small-bowel tumors (SBTs) are rare entities and pose a unique diagnostic and management challenge. Until the advent of capsule endoscopy (CE) and device-assisted enteroscopy (DAE) coupled with the advances in radiology, physicians had limited diagnostic tests for investigating the small bowel. CE allows a direct entire evaluation of the small bowel and has become the frontline diagnostic tool in case of suspected small-bowel diseases. DAE allows histopathological diagnosis and deeper enteroscopy. CT enteroclysis/CT enterography (CTE) provides not only pictures of the luminal side but also information about adjacent organs. Magnetic resonance enteroclysis/enterography compared to CTE offers the advantage of soft tissue contrast and multiplanar imaging without radiation exposure.

Polyps of the small bowel can be inflammatory, hyperplastic, hamartomatous, and adenomas. Hamartomatous polyps and adenomas may arise sporadically or belong to polyposis syndromes that are associated with an increased risk of gastrointestinal cancer. Familial Adenomatous Polyposis (FAP) and Peutz-Jeghers syndrome (PJS) are the most common inherited intestinal polyposis syndromes. The clinical usefulness and cost-effectiveness of routine small-bowel screening and surveillance in FAP patients are not known at this time. The current evidence does not support routine prophylactic examination of the deep small bowel in this disorder. On the other hand, PJS is conversely a domain where CE and DAE best exhibit their diagnostic and therapeutic power.

Keywords

Small-bowel tumors Small-bowel polyps Polyposis syndromes Capsule endoscopy Device-assisted enteroscopy CT enterography MR enterography Familial adenomatous polyposis Peutz-Jeghers syndrome 

Supplementary material

Video 13.1

Endoscopic biopsy of a large jejunal melanoma (MP4 2,425 kb)

Video 13.2

Very large jejunal polyp on DAE in a patient referred for OGIB (MP4 11,018 kb)

Video 13.3

Demonstration of endoscopic marking of SBT (MP4 9,481 kb)

Video 13.4

DAE with multiple endoscopic polypectomies in PJS (MP4 5,774 kb)

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Alessandra Bizzotto
    • 1
  • Maria Elena Riccioni
    • 1
    Email author
  • Rosario Landi
    • 1
  • Clelia Marmo
    • 1
  • Brunella Barbaro
    • 2
  • Guido Costamagna
    • 1
  1. 1.Digestive Endoscopy UnitUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Department of Bioimaging and Radiological SciencesUniversità Cattolica del Sacro CuoreRomeItaly

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