Endoscopy 2008; 40(6): 488-495
DOI: 10.1055/s-2007-995783
Original article

© Georg Thieme Verlag KG Stuttgart · New York

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

E.  Rondonotti1 , M.  Pennazio2 , E.  Toth3 , P.  Menchen4 , M.  E.  Riccioni5 , G.  D.  De Palma6 , F.  Scotto7 , D.  De Looze8 , T.  Pachofsky9 , I.  Tacheci10 , T.  Havelund11 , G.  Couto12 , A.  Trifan13 , A.  Kofokotsios14 , R.  Cannizzaro15 , E.  Perez-Quadrado16 , R.  de Franchis1 on behalf of the European Capsule Endoscopy Group (ECEG), the Italian Club for Capsule Endoscopy (CICE) and the Iberian Group for Capsule Endoscopy (IGCE). Also see Appendix for additional contributors.
  • 1Department of Internal Medicine, Gastroenterology 3 Unit, University of Milan, IRCCS Policlinico, Mangiagalli and Regina Elena Foundation, Milan, Italy
  • 2Department of Gastroenterology and Clinical Nutrition, S. Giovanni AS Hospital, Turin, Italy
  • 3Endoscopy Unit, Department of Medicine, Malmo University Hospital, Malmo, Sweden
  • 4Endoscopy Unit, Gregorio Maranon University Hospital, Madrid, Spain
  • 5Unità Operativa di Endoscopia Digestiva e Chirurgica, Dipartimento di Scienze chirurgiche, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
  • 6Department of Surgery and Advanced Technologies, School of Medicine, University of Naples Federico II, Naples, Italy
  • 7Unità Operativa di Gastroenterologia ed Endoscopi Digestiva Istituto Tumori Giovanni Paolo II, Bari, Italy
  • 8Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
  • 9Gastroenterology Unit, Krankenanstalt Rudolfstiftung, Vienna, Austria
  • 10Second Department of Internal Medicine, Faculty of Medicine and Teaching Hospital, Charles University, Hradec Kralove, Czech Republic
  • 11Gastroenterology Unit, Department of Internal Medicine, Odense University Hospital, Odense, Denmark
  • 12Servicio de Gastroenterologia, Hospital de Egas Moniz, Lisbon, Portugal
  • 13Gastroenterology Unit, Institute of Gastroenterology and Hepatology, Iasi, Romania
  • 14Department of Gastroenterology, Euromedica Geniki Clinici Thessalonikis Thessalonika, Grece
  • 15Unità Operativa di Gastroenterologia, Centro di Riferimento Oncologico, Aviano, Italy
  • 16Small Bowel Unit, Hospital Morales Meseguer, Murcia, Spain
Weitere Informationen

Publikationsverlauf

submitted 4 September 2007

accepted after revision 16 January 2008

Publikationsdatum:
08. Mai 2008 (online)

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 VCE 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 VCE, 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 work-up and influence the subsequent management of these patients.

References

  • 1 Neugut A I, Jacobson J S, Suh S. et al . The epidemiology of cancer of the small bowel.  Cancer Epidemiol Biomarkers Prev. 1998;  7 243-251
  • 2 Delaunoit T, Neczyporenko F, Limburg P J. et al . Pathogenesis and risk factors of small bowel adenocarcinoma: a colorectal cancer sibling?.  Am J Gastroenterol. 2005;  100 703-710
  • 3 Di Sarjo J A, Burt R W, Vargas H. et al . Small bowel cancer: epidemiological and clinical characteristics from a population-based registry.  Am J Gastroenterol. 1994;  89 699-701
  • 4 Barclay T C, Schapira D V. Malignant tumors of the small intestine.  Cancer. 1983;  51 878-881
  • 5 Blanchard D K, Budde J M, Hatch G F. et al . Tumors of the small intestine.  World J Surg. 2000;  24 421-429
  • 6 O’Riordan B G, Vilor M, Herrera L. Small bowel tumors: an overview.  Dig Dis Sci. 1996;  14 245-257
  • 7 Gill S, Heuman D M, Mihas A A. Small intestinal neoplasms.  J Clin Gastroenterol. 2001;  33 267-282
  • 8 Wilson J M, Melvin D B, Gray G F. et al . Primary malignancies of the small bowel: a report of 96 cases and review of the literature.  Ann Surg. 1974;  180 175-179
  • 9 Johnson A M, Harman P K, Hanks J B. Primary small bowel malignancies.  Am Surg. 1985;  51 31-36
  • 10 Das Gupta T K, Brasfield R D. Metastatic melanoma of the gastrointestinal tract.  Arch Surg. 1964;  88 969-973
  • 11 Reintgen D S, Thompson W, Garbutt J, Seigler H F. Radiologic, endoscopic and surgical considerations of melanoma metastatic to the gastrointestinal tract.  Surgery. 1984;  95 635-639
  • 12 Talamonti M S, Goetz L H, Rao S. et al . Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management.  Arch Surg. 2002;  137 564-570; discussion 570-571
  • 13 de Franchis R, Rondonotti E, Abbiati C. et al . Small bowel malignancy.  Gastrointest Endosc Clin N Am. 2004;  14 139-148
  • 14 Cobrin G, Pittman R, Lewis S B. Increased diagnostic yield of small bowel tumors with capsule endoscopy.  Cancer. 2006;  107 22-26
  • 15 Bailey A, Debinski H S, Appleyard M N. et al . Diagnosis and outcome of small bowel tumors found by capsule endoscopy: a three-center Australian experience.  Am J Gastroenterol. 2006;  101 2237-2243
  • 16 Estevez E, Gonzalez-Conde B, Vazquez-Iglesias J L. et al . Incidence of tumoral pathology according to study using capsule endoscopy for patients with obscure gastrointestinal bleeding.  Surg Endosc. 2007;  [Epub ahead of print]
  • 17 Urbain D, DeLooze D, Demedts I. et al . Video capsule endoscopy in small-bowel malignancy: a multicenter Belgian study.  Endoscopy. 2006;  38 408-411
  • 18 Schwartz G D, Barkin J S. Small-bowel tumors detected by wireless capsule endoscopy.  Dig Dis Sci. 2007;  52 1026-1030
  • 19 Triester S L, Leighton J A, Leontiadis G I. et al . A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding.  Am J Gastroenterol. 2005;  100 2407-2418
  • 20 de Leusse A, Vahedi K, Edery J. et al . Capsule endoscopy for first line exploration of obscure gastrointestinal bleeding.  Gastroenterology. 2007;  132 855-862
  • 21 Lewis B S, Eisen G M, Friedman S. Pooled analysis to evaluate results of capsule endoscopy trials.  Endoscopy. 2005;  37 960-965
  • 22 Pennazio M, Santucci R, Rondonotti E. et al . Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases.  Gastroenterology. 2004;  126 643-653
  • 23 Pasha S F, Sharma V K, Carey E J. et al . Utility of video capsule endoscopy in the detection of small bowel tumors - A single center experience of 1000 consecutive patients.  International Conference on Capsule Endoscopy. 2007;  abstracts 45
  • 24 Chong A K, Chin B W, Meredith C G. Clinically significant small-bowel pathology identified by double-balloon enteroscopy but missed by capsule endoscopy.  Gastrointest Endosc. 2006;  64 445-449
  • 25 Concha R, Amaro R, Barkin J S. Obscure gastrointestinal bleeding: diagnostic and therapeutic approach.  J Clin Gastroenterol. 2007;  41 242-251
  • 26 Redondo-Cerezo E, Perez-Vigara G. et al . Diagnostic yield and impact of capsule endoscopy on management of patients with gastrointestinal bleeding of obscure origin.  Dig Dis Sci. 2007;  52 1376-1381
  • 27 Miettinen M, Lasota J. Gastrointestinal stromal tumours: review on morphology, molecular pathology, prognosis and differential diagnosis.  Arch Pathol Lab Med. 2006;  130 1446-1478
  • 28 Miettinen M, Sobin L H, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up.  Am J Surg Pathol. 2005;  29 52-68
  • 29 Miettinen M, Makhlouf H R, Sobin L H. et al . Gastrointestinal stromal tumors (GISTs) of the jejunum and ileum: a clinicopathologic, immunohistochemical and molecular genetic study of 906 cases prior to imatinib with long-term follow-up.  Am J Surg Pathol. 2006;  30 477-489
  • 30 Bender G N, Maglinte D D, MCLarney J H. et al . Malignant melanoma: patterns of metastasis to the small bowel, reliability of imaging studies, and clinical relevance.  Am J Gastroenterol. 2001;  96 2392-2400
  • 31 De Francesco V, Stoppino G, Tonti P. et al . Ileal metastasis from thoracic melanoma disclosed by video capsule endoscopy: an unusual but not extraordinary source of obscure bleeding.  Endoscopy. 2007;  39 (Suppl 1) E109 [Epub ahead of print]
  • 32 Liangpunsakul S, Chadalawada V, Rex D K. et al . Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysis.  Am J Gastroenterol. 2003;  98 1295-1298
  • 33 Kalantzis C, Apostolopoulos P, Mavrogiannis P. et al . Capsule endoscopy retention as a helpful tool in the management of a young patient with suspected small-bowel disease.  World J Gastroenterol. 2007;  13 1289-1291
  • 34 Cheifetz A S, Kornbluth A A, Legnani P. et al . The risk of retention of the capsule endoscope in patients with known or suspected Crohn’s disease.  Am J Gastroenterol. 2006;  101 2218-2222
  • 35 Cave D, Legnani P, de Franchis R. et al . ICCE consensus for capsule retention.  Endoscopy. 2005;  37 1065-1067
  • 36 Lee B, Choi H, Choi K Y. et al . Retrieval of a retained capsule endoscope by double-balloon enteroscopy.  Gastrointest Endosc. 2005;  62 463-465
  • 37 Delvaux M, Ben S oussan, Laurent V. et al . Clinical evaluation of the use of M2A patency capsule system before a capsule endoscopy procedure in patients with known or suspected intestinal stenosis.  Endoscopy. 2005;  37 801-807
  • 38 Spada C, Spera G, Riccioni M. et al . A novel diagnostic tool for detecting functional patency of the small bowel: the Given Patency Capsule.  Endoscopy. 2005;  37 793-800
  • 39 Gay G, Delvaux M, Laurent V. et al . Temporary intestinal occlusion induced by a patency capsule in a patient with Crohn’s disease.  Endoscopy. 2005;  37 793-800
  • 40 Signorelli C, Rondonotti E, Villa F. et al . Use of the Given Patency System for the screening of patients at high risk for capsule retention.  Dig Liver Dis. 2006;  38 326-330
  • 41 Spada C, Shah S K, Riccioni M E. et al . Video capsule endoscopy in patients with known or suspected small bowel stricture previously tested with the dissolving patency capsule.  J Clin Gastroenterol. 2007;  41 576-582

E. Rondonotti, MD 

Università degli Studi di Milano
IRCCS Fondazione Policlinico, Mangiagalli, Regina Elena
Dipartimento di Scienze Mediche
Unità Operativa Gastroenterologia 3

Via Pace 9
20122 Milano
Italy

Fax: +39-02-50320747

eMail: emanuele.rondonotti@unimi.it