Should we perform regular surveillance capsule endoscopies in patients following small-bowel adenocarcinoma resection? A case report and discussion

Abstract

Because small-bowel tumors are rare, prospective data on the utility of video capsule endoscopy (VCE) for their detection are limited. Current guidelines do not advocate for surveillance VCEs in patients following small-bowel tumor resection, which is mostly due to a lack of data. Here, we report an 81-year-old male patient who had undergone curative segmental ileal adenocarcinoma resection 15 years ago and another segmental jejunal adenocarcinoma resection (TNM-Classification: pT2 pN0 (0/2) G2M0) 7 years ago. He now presents with melena, progressive dyspnea, and decreased hemoglobin levels. VCE revealed local intestinal recurrence of the previously resected jejunal adenocarcinoma, leading to a second segmental jejunal resection (TNM-Classification: pT3 L1 pN0 (0/5) G2 M0). We believe that regular surveillance VCEs after the first jejunal adenocarcinoma resection might have facilitated earlier detection of tumor recurrence in this patient’s case. Therefore, we suggest considering regular surveillance VCEs, at least in patients with recurrent small-bowel malignancies. However, future prospective studies are warranted to validate our findings.

Zusammenfassung

Aufgrund der Seltenheit von Dünndarmtumoren, gibt es nur wenige prospektive Daten über den Nutzen der Videokapselendoskopie (VCE) für ihre Detektion. Aktuelle Leitlinien empfehlen keine Überwachungs-VCE bei Patienten nach Dünndarmkarzinomresektion, was hauptsächlich auf den Mangel an wissenschaftlichen Daten zurückzuführen ist. Wir berichten von einem 81-jährigen Patienten, der sich vor 15 Jahren einer kurativen segmentalen Adenokarzinomresektion des Ileums und vor 7 Jahren einer weiteren segmentalen Adenokarzinomresektion des Jejunums (TNM-Klassifikation: pT2 pN0 (0/2) G2M0) unterzogen hatte. Er stellte sich nun mit Teerstuhl, progressiver Dyspnoe und einem Hämoglobinabfall vor. Mittels VCE wurde ein lokales Rezidiv des zuvor resezierten jejunalen Adenokarzinoms festgestellt, was eine zweite segmentale Resektion des Jejunums zur Folge hatte (TNM-Klassifikation: pT3 L1 pN0 (0/5) G2 M0). Wir sind der Ansicht, dass regelmäßige Überwachungs-VCE nach der ersten jejunalen Adenokarzinomresektion eine frühere Erkennung des Tumorrezidivs bei diesem Patienten ermöglicht hätte. Auf Grundlage dessen erscheint es sinnvoll, zumindest bei Patienten mit rezidivierenden Dünndarmmalignomen, regelmäßige Überwachungs-VCE in Betracht zu ziehen. Diese Schlussfolgerung sollte jedoch durch zukünftige prospektive Studien noch weiter validiert werden.

Keywords

small-bowel cancer - small intestine - adenocarcinoma - relapse - surveillance - follow-up capsule endoscopy

Schlüsselwörter

Dünndarmkarzinom - Dünndarm - Adenokarzinom - Kontrolluntersuchung - Rezidiv - Nachsorgekapselendoskopie

Publication History

Received: 02 June 2024

Article published online:
19 July 2024

• References

• 1 Tontini GE, Wiedbrauck F, Cavallaro F. et al. PWE-049 Small-Bowel Capsule Endoscopy with 360° Panoramic-View: Results of The First Multicenter, Observational, Study. Gut 2016; 65: A162
• 2 Wiedbrauck D, Rymaszewska JE, Hollerbach S. et al. Familial Adenomatous Polyposis With Concomitant Celiac Disease: An Unexpected Finding on Capsule Endoscopy With a Panoramic View. Am J Gastroenterol 2023; 118: 398
• 3 Barsouk A, Rawla P, Barsouk A. et al. Epidemiology of Cancers of the Small Intestine: Trends, Risk Factors, and Prevention. Med Sci (Basel) 2019; 7
• 4 Lewis BS, Keuchel M, Wiedbrauck F. et al. Malignant Tumors. In: Keuchel M, Hagenmüller F, Tajiri H. Video Capsule Endoscopy: A Reference Guide and Atlas. Berlin, Heidelberg: Springer Berlin Heidelberg; 2014: 337-358
• 5 Huang J, Chan SC, Fung Y. et al. Incidence, Risk Factors, and Temporal Trends of Small Intestinal Cancer: A Global Analysis of Cancer Registries. Gastroenterology 2023; 165
• 6 Yung DE, Rondonotti E, Giannakou A. et al. Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy. United European Gastroenterol J 2017; 5: 974-981
• 7 Calabrese C, Gionchetti P, Calafiore A. et al. Sporadic small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding. Internal and Emergency Medicine 2015; 10
• 8 Perez-Cuadrado-Robles E, Delgado P, Andrés B. et al. Diagnosis agreement between capsule endoscopy and double-balloon enteroscopy in obscure gastrointestinal bleeding at a referral center. Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva 2015; 107
• 9 Ishikawa-Kakiya Y, Shiba M, Okamoto J. et al. A comparison between capsule endoscopy and double balloon enteroscopy using propensity score-matching analysis in patients with previous obscure gastrointestinal bleeding. Scandinavian journal of gastroenterology 2016; 52: 1-6
• 10 Segarajasingam D, Hanley S, Barkun A. et al. Randomized Controlled Trial Comparing Outcomes of Video Capsule Endoscopy with Push Enteroscopy in Obscure Gastrointestinal Bleeding. Canadian journal of gastroenterology & hepatology 2015; 29: 85-90
• 11 Pennazio M, Rondonotti E, Despott EJ. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy 2023; 55: 58-95
• 12 Enns RA, Hookey L, Armstrong D. et al. Clinical Practice Guidelines for the Use of Video Capsule Endoscopy. Gastroenterology 2017; 152: 497-514
• 13 De Palma GD, Rega M, Puzziello A. et al. Capsule endoscopy is safe and effective after small-bowel resection. Gastrointest Endosc 2004; 60: 135-138
• 14 Colina A, Hwang H, Wang H. et al. Natural history and prognostic factors for localised small bowel adenocarcinoma. ESMO Open 2020; 5: e000960