Endoscopy 2003; 35(10): 861-864
DOI: 10.1055/s-2003-42624
Case Report
© Georg Thieme Verlag Stuttgart · New York

Locally Advanced Small-Bowel Adenocarcinoma Missed Primarily by Capsule Endoscopy but Diagnosed by Push Enteroscopy

A.  Madisch 1 , W.  Schimming 2 , F.  Kinzel 1 , R.  Schneider 1 , D.  Aust 3 , D.  M.  Ockert 4 , M.  Laniado 5 , G.  Ehninger 1 , S.  Miehlke 1
  • 1Dept. of Medicine I, Technical University Hospital, Dresden, Germany
  • 2Dept. of Gastroenterology, Dresden-Neustadt Hospital, Dresden, Germany
  • 3Institute of Pathology, Technical University Hospital, Dresden, Germany
  • 4Dept. of Surgery, Technical University Hospital, Dresden, Germany
  • 5Dept. of Diagnostic Radiology, Technical University Hospital, Dresden, Germany
Further Information

Publication History

Submitted 20 June 2003

Accepted after Revision 13 July 2003

Publication Date:
10 October 2003 (online)

Wireless-capsule-endoscopy is a new painless method that is able both to visualize the entire small bowel and to detect even small lesions. We report here the case of a patient in whom a locally advanced small-bowel adenocarcinoma was initially missed on capsule endoscopy, but was diagnosed by subsequent push enteroscopy. Capsule endoscopy was carried out in a 47-year-old patient with a history of obscure gastrointestinal bleeding, iron-deficiency anemia, and a lack of symptoms suggestive of stenosis. The capsule imaging revealed angiodysplasias in the jejunum, but no other abnormalities. Push enteroscopy was carried out to allow argon plasma coagulation treatment of the angiodysplasias that had been detected; it revealed a polypoid tumor 20 mm in diameter at 150 cm from the incisors, with the capsule endoscope still located proximal to the tumor and with its optical dome turned towards the push enteroscope. Clinical staging and subsequent surgical resection showed a locally advanced adenocarcinoma (pT4, pN0 (0/7), pMx, G3).
Small-bowel tumors within the reach of push enteroscopy may be missed by capsule endoscopy. Although wireless capsule endoscopy is a major advance in the investigation of the small bowel, well-designed clinical studies still need to define the precise algorithm for diagnostic work-up of suspected small-bowel diseases.

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A. Madisch, M. D.

Dept. of Medicine I, Technical University Hospital

Fetscherstrasse 74 · 01307 Dresden · Germany

Fax: + 49-351-458 4394

Email: madisch@mk1.med.tu-dresden.de