Z Gastroenterol 2013; 51 - A55
DOI: 10.1055/s-0033-1347430

Bleeding from primary and metastatic melanomas of the small bowel: a systematic study on the epidemiology and enteroscopic appearance

R Schwarzer 1, E Dulic-Lakovic 1, W Dolak 2, T Pachofszky 3, C Datz 4, D Hubner 5, H Schwaighofer 6, H Fuchssteiner 7, G Gahbauer 8, A Püspök 2, T Pulgram 3, P Knoflach 5, W Vogel 6, A Maieron 7, M Gschwantler 1
  • 1Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
  • 2Medical University Vienna, Department of Internal Medicine III, Vienna, Austria
  • 3Rudolfstiftung, Department of Internal Medicine IV, Vienna, Austria
  • 4Hospital Oberndorf, Department of Internal Medicine, Oberndorf, Austria
  • 5Klinikum Wels, Department of Internal Medicine I, Wels, Austria
  • 6Medical University Innsbruck, Department of Internal Medicine II, Innsbruck, Austria
  • 7Elisabethinen Hospital, Department of Internal Medicine, Linz, Austria
  • 8Hospital Barmherzige Schwestern, Department of Internal Medicine, Ried im Innkreis, Austria

Introduction: Melanomas are rare tumours of the small bowel. To our best knowledge this is the first systematic study on the epidemiology and enteroscopic appearance of this entity.

Patients and Methods: Eight Austrian centres, at which double-balloon enteroscopy (DBE; n = 5) or single-balloon enteroscopy (SBE; n = 3) had been established, participated in this study. All patients who underwent DBE or SBE because of a suspicion of mid-gastrointestinal bleeding between December 2004 and April 2012 were included in this analysis. Primary and metastatic melanomas of the small bowel were differentiated according to the criteria of Becker et al.

Results: A total of 609 enteroscopies performed in 445 consecutive patients (m/f: 256/189; mean age ± SD: 65.1 ± 15.8 years) were analysed. A bleeding source within the small bowel could be identified in 61.1% of patients. A melanoma of the small bowel was diagnosed in 6 patients (m/f: 6/0; mean age ± SD: 63.2 ± 15.9 years), corresponding to 1.3% of the study population. Melanomas were classified as metastatic in five and primary in one case. Metastatic melanomas presented as multiple polypoid lesions with ulceration. With the exception of one metastasis in the ileum, all lesions were located in the duodenum or jejunum. The only primary melanoma of this study presented as infiltrating tumour with ulceration and was located 50 cm distal from the pylorus. Despite of a multimodal treatment approach four of five patients with metastatic melanoma died after a mean of 2.5 ± 0.6 months after diagnosis; one patient is still alive after a follow-up of 22 months. The patient with primary melanoma died 26 months after diagnosis.

Discussion: Metastatic or primary melanomas of the small bowel represented the bleeding source in 1.3% of patients who underwent DBE or SBE for evaluation of mid-gastrointestinal bleeding. Prognosis is poor in most patients.