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
Further Information

Publication History

submitted 4 September 2007

accepted after revision 16 January 2008

Publication Date:
08 May 2008 (online)

Also available at
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Commentaire de travail de E. Rondonotti et al., pp. 488Endoscopy 2008; 40(06): 545-545
DOI: 10.1055/s-0032-1306843

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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 4 Barclay T C, Schapira D V. Malignant tumors of the small intestine.  Cancer. 1983;  51 878-881
    CrossrefPubMedGoogle Scholar
  • 5 Blanchard D K, Budde J M, Hatch G F. et al . Tumors of the small intestine.  World J Surg. 2000;  24 421-429
    CrossrefPubMedGoogle Scholar
  • 6 O’Riordan B G, Vilor M, Herrera L. Small bowel tumors: an overview.  Dig Dis Sci. 1996;  14 245-257
    CrossrefPubMedGoogle Scholar
  • 7 Gill S, Heuman D M, Mihas A A. Small intestinal neoplasms.  J Clin Gastroenterol. 2001;  33 267-282
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 9 Johnson A M, Harman P K, Hanks J B. Primary small bowel malignancies.  Am Surg. 1985;  51 31-36
    PubMedGoogle Scholar
  • 10 Das Gupta T K, Brasfield R D. Metastatic melanoma of the gastrointestinal tract.  Arch Surg. 1964;  88 969-973
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 13 de Franchis R, Rondonotti E, Abbiati C. et al . Small bowel malignancy.  Gastrointest Endosc Clin N Am. 2004;  14 139-148
    PubMedGoogle Scholar
  • 14 Cobrin G, Pittman R, Lewis S B. Increased diagnostic yield of small bowel tumors with capsule endoscopy.  Cancer. 2006;  107 22-26
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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]
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Schwartz G D, Barkin J S. Small-bowel tumors detected by wireless capsule endoscopy.  Dig Dis Sci. 2007;  52 1026-1030
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 21 Lewis B S, Eisen G M, Friedman S. Pooled analysis to evaluate results of capsule endoscopy trials.  Endoscopy. 2005;  37 960-965
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 25 Concha R, Amaro R, Barkin J S. Obscure gastrointestinal bleeding: diagnostic and therapeutic approach.  J Clin Gastroenterol. 2007;  41 242-251
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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]
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 35 Cave D, Legnani P, de Franchis R. et al . ICCE consensus for capsule retention.  Endoscopy. 2005;  37 1065-1067
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

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