Small-bowel neoplasms in patients undergoing video capsule endoscopy: a multicenter European study

Background and study aim: Small-bowel tumors account for 1%-3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency, clinical presentation, diagnostic/therapeutic work-up, and endoscopic appearance of small-bowel tumors in a large population of patients undergoing VCE. Patients and methods: Identification by a questionnaire of patients with VCE findings suggesting small-bowel tumors and histological confirmation of the neoplasm seen in 29 centers of 10 European Countries. Results: Of 5129 patients undergoing VCE, 124 (2.4%) had small-bowel tumors (112 primary, 12 metastatic). Among these patients, indications for VCE were: obscure gastrointestinal bleeding (108 patients), abdominal pain (9), search for primary neoplasm (6), diarrhea with malabsorption (1). The main primary small-bowel tumor type was gastrointestinal stromal tumor (GIST) (32%) followed by adenocarcinoma (20%) and carcinoid (15%); 66% of secondary small-bowel tumors were melanomas. Of the tumors, 80.6% were identified solely on the basis of VCE findings. 55 patients underwent WE as the third procedure after negative bidirectional endoscopy. The lesions were single in 89.5 % of cases, and multiple in 10.5%. Retention of the capsule occurred in 9.8% of patients with small-bowel tumors. After VICE, 54/124 patients underwent 57 other examinations before treatment; in these patients enteroscopy, when performed, showed a high diagnostic yield. Treatment was surgery in 95% of cases. Conclusions: Our data suggest that VCE detects small-bowel tumors in a small proportion of patients undergoing this examination, but the early use of this tool can shorten the diagnostic workup and influence the subsequent management of these patients

small bowel neoplasms in patients undergoing video capsule endoscopy: a multicenter european study

Background: small bowel (SB) tumors account for 1-3% of all GI neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previusly reported.Aim of the study: to evaluate frequency, clinical presentation, diagnostic/therapeutic work-up and endoscopic appearance of SB tumors in a large population of patients undergoing VCE.Methods: identification by specific questionnaire of all patients with VCE findings suggesting SB tumors and histological confirmation of the neoplasm seen in 29 centers of 10 European counries Results:124/5129 patients undergoing VCE (2.4%) had SB tumors (112 primitive,12 metastatic).Indication for VCE: obscure GI bleeding (108 patients), abdominal pain (9), research for primitive neoplasm (6), diarrhea with malabsorption (1). 80.6% of the tumors were identified solely based on VCE findings. 55 patients underwent VCE as the thierd procedure after a negative bidiretional endoscopy; 69 underwent a mean of 1.47 examinations before VCE. the lesions were single in 89.5% of cases, multiple in 10.5%. VCE retention occurred in 9.8% of patients. After VCE, 54 patients underwent 57 other examinations before treatment. The diagnostic yield of enteroscopy performed before VCE was 9%, compared with 77% when performed after a positive VCE examination (p<0.0001). Treatment was surgery in 92% of cases. Conclusions: In our series the frequency of SB tumors was 2.4%.The majority of patients had obscure GI bleeding.VCE results led directly to treatment in 47% of patients, and oriented the subsequent endoscopic work up in 28%

Increased diagnostic yield of small bowel tumors with PillCam: the role of capsule endoscopy in the diagnosis and treatment of gastrointestinal stromal tumors (GISTs). Italian single-center experience.

Background. Gastrointestinal stromal tumors (GISTs) are rare tumors, accounting for 1-3% of all gastrointestinal malignancies; they are, however, the most common gastric and small bowel mesenchymal tumors. The length and relative inaccessibility of the small bowel have long constrained the diagnosis of GISTs mainly presenting with chronic or intermittent bleeding as the sole clinical manifestation. Aim. To report on the prevalence of small bowel GISTs in a prospectively recorded series of patients undergoing capsule endoscopy (CE). Patients and methods. Between 2001 and 2007 five hundred patients were referred to our endoscopy unit for small bowel evaluation with capsule endoscopy. We retrospectively evaluated all charts. The main indications for CE were obscure-occult or obscure-overt bleeding. Two hundred eighty-nine patients underwent CE for either obscure-occult or obscure-overt bleeding and 211 for other indications. Patient outcome and care processes were measured by follow-up telephone interviews and chart review. Statistical computations were performed using Fisher\u2019s exact test and Student\u2019s t-test. Results. CE identified a small bowel tumor in 20 patients (4.0%) and 9 tumors turned out to be GISTs (45.0%). Traditional endoscopic and radiological imaging failed to detect the GIST in all these cases. In one case a small bowel GIST was diagnosed by angiography and CE proved false negative. Overall, CE was able to diagnose a small bowel GIST in 9 out of 10 cases. All patients underwent surgical treatment and showed normalized hemoglobin levels at follow-up. The main limitation of this study is the small number of cases. Conclusions. CE is an effective and sensitive diagnostic device compared with conventional radiology and plays an important role in the algorithm for the diagnostic work-up of suspected small bowel tumors