Advance in diagnosis and treatment of small bowel tumors: a single-center report

Riccioni, Maria Elena; Cianci, Rossella; Urgesi, Riccardo; Bizzotto, Alessandra; Spada, Cristiano; Rizzo, Giulia; Coco, Claudio; Costamagna, Guido

doi:10.1007/s00464-011-1896-6

Cited by 10 publications

(8 citation statements)

References 16 publications

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“…This is in concordance with the findings of others 3 , who also explained that the initially sampled tissue can be superficial to the targeted lesion. Additionally, 100 % agreement regarding histological and laparoscopically resected specimens was shown for DBE 39 , with the fact taken into consideration that in five cases of suspected GIST, biopsies were not obtained. Afterward, four GISTs and one gastrointestinal autonomic tumor (GANT) were further confirmed surgically.…”

Section: Discussionmentioning

confidence: 88%

“…Taking into consideration studies that provided surgical specimen histopathological data 32 39 40 , we demonstrated that in 80 % of the DBE biopsies that missed the diagnosis, the lesions were of subepithelial origin. The misdiagnosed lesions included three gastrointestinal stromal tumors (GISTs), one leiomyoma, and one adenocarcinoma, demonstrating a low histological diagnostic yield for DBE in subepithelial tumors.…”

Section: Discussionmentioning

confidence: 96%

“…Mass lesions are typically focal and thus more likely to be missed. False-positive data for submucosal tumors on CE may also be due to transient bulges into the lumen of the small bowel 39 . Although it has been stated that CE can miss mass lesions located in the proximal small bowel because of the high velocity of the capsule as it passes along the duodenal sweep and the currently limited angle of view 40 42 43 , no clear association between tumor location and missed CE lesions was found in this review.…”

Section: Discussionmentioning

confidence: 99%

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Overtube-assisted enteroscopy and capsule endoscopy for the diagnosis of small-bowel polyps and tumors: a systematic review and meta-analysis

et al. 2016

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Background and study aims: Several studies have evaluated the utility of double-balloon enteroscopy (DBE) and capsule endoscopy (CE) for patients with small-bowel disease showing inconsistent results. The aim of this study was to determine the sensitivity and specificity of overtube-assisted enteroscopy (OAE) as well as the diagnostic concordance between OAE and CE for small-bowel polyps and tumors. Patients and methods: We conducted a systematic review and meta-analysis of studies in which the results of OAE were compared with the results of CE for the evaluation of small-bowel polyps and tumors. When data for surgically resected lesions were available, the histopathological results of OAE and surgical specimens were compared. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the diagnosis of small-bowel polyps and tumors were analyzed. Secondarily, the rates of diagnostic concordance and discordance between OAE and CE were calculated. Results: There were 15 full-length studies with a total of 821 patients that met the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were as follows: 0.89 (95 % confidence interval [CI] 0.84 – 0.93), with heterogeneity χ2 = 41.23 (P = 0.0002) and inconsistency (I 2) = 66.0 %; 0.97 (95 %CI 0.95 – 0.98), with heterogeneity χ2 = 45.27 (P = 0.07) and inconsistency (I 2) = 69.1 %; 16.61 (95 %CI 3.74 – 73.82), with heterogeneity Cochrane’s Q = 225.19 (P < 0.01) and inconsistency (I 2) = 93.8 %; and 0.14 (95 %CI 0.05 – 0.35), with heterogeneity Cochrane’s Q = 81.01 (P < .01) and inconsistency (I 2) = 82.7 %, respectively. A summary receiver operating characteristic curve (SROC) curve was constructed, and the area under the curve (AUC) was 0.97. Conclusion: OAE is an accurate test for the detection of small-bowel polyps and tumors. OAE and CE have a high diagnostic concordance rate for small-bowel polyps and tumors.This study was registered in the PROSPERO international database () with the study number CRD42015016000.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Overtube-assisted enteroscopy and capsule endoscopy for the diagnosis of small-bowel polyps and tumors: a systematic review and meta-analysis

et al. 2016

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“…Nevertheless, the diagnosis of SBMLs is difficult owing to their low incidence, nonspe-Manuscript submitted October 29, 2022, accepted December 8, 2022 Published online December 18, 2022 cific clinical presentation, and location beyond the reach of standard endoscopic evaluation [1,3]. Indeed, up until the past two decades, these lesions were typically only diagnosed with surgical laparotomy [4,5]. Since its approval in 2001, video capsule endoscopy (VCE) has played a significant role in detecting SBMLs in patients presenting with a variety of complaints ranging from occult GI bleeding to abdominal pain and weight loss.…”

Section: Introductionmentioning

confidence: 99%

“…Since its approval in 2001, video capsule endoscopy (VCE) has played a significant role in detecting SBMLs in patients presenting with a variety of complaints ranging from occult GI bleeding to abdominal pain and weight loss. As it typically allows for inspection of the entire small bowel and has a diagnostic yield as high as 91% for detecting SBMLs, the incidence of detected SBMLs increased from 11.8 cases per million in 1973 to 22.7 cases per million in 2004 [3][4][5][6][7][8][9]. Though VCE has become the preferred first-line method for luminal small bowel evaluation, it is limited by its inability to provide a tissue diagnosis [1,3,8,10].…”

Section: Introductionmentioning

confidence: 99%

Clinical Features and Management of Small Bowel Masses Detected During Device-Assisted Enteroscopy: A Multi-Center Experience

et al. 2022

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Background: Small bowel mass lesions (SBMLs) are rare, span a range of different histologies and phenotypes, and our understanding of them is limited. Some lesions occur in patients with recognized polyposis syndromes and others arise sporadically. The current literature regarding SBMLs is limited to small retrospective studies, case reports, and small case series. This large multi-center study aims to understand the various clinical presentations, histologies and management options for SBMLs. Methods:After obtaining Institutional Review Board (IRB) approval, electronic records were used to identify all device-assisted enteroscopy (DAE) performed for luminal small bowel evaluation in adult patients at three US referral centers (Duke, LSU and UMass) from January 1, 2014, to October 1, 2020. We identified all patients within this cohort in whom a SBML was detected. Using a focused electronic medical record chart review, we collected patient, procedure, and lesion-related data and used descriptive statistics to explore relationships between these data and outcomes.Results: A total of 218 patients (49 at Duke, 148 at LSU, and 21 at UMass) in this cohort had at least one SBML found on DAE. The most common presenting symptoms were iron-deficiency anemia/ bleeding (73.3%) and abnormal imaging (33.6%). Thirty-five percent of patients had symptoms for more than a year prior to their diagnosis. Most patients (71.6%) underwent video capsule endoscopy (VCE) prior to DAE and 84% of these exams showed the lesion. The lesion was seen less frequently (48.9%) on computed tomography (CT) scan performed prior to DAE. The majority of lesions were found on antegrade (56%) or retrograde (29.8%) double-balloon enteroscopy (DBE). The most common lesion phenotypes were submucosal (41.3%) and pedunculated (33%) with a much smaller number being sessile (14.7%) or obstructing/invasive (11%). They were found equally as commonly in the jejunum (46.3%) and ileum (49.5%). Most lesions were 10 -20 mm in size (47%) but 22.1% were larger than 20 mm. The most common histologies were neuroendocrine tumors (NETs, 20.6%) and hamartomas (20.6%). Primary adenocarcinoma of the small bowel was rare, constituting only 5% of lesions. The majority of polyps (78.4%) were sporadic, compared to 21.7% associated with a polyposis or hereditary cancer syndrome, most commonly Peutz-Jeghers syndrome (18.3%). After DAE, 37.6% were advised to undergo surgical resection and 48% were advised to undergo endoscopic surveillance or no further management because of benign histology or successful endoscopic resection. Conclusions:In this multi-center retrospective study we found that SBMLs are more likely to be sporadic than syndromic, medium in size and either pedunculated or submucosal. NETs and hamartomas predominated and symptoms, most commonly anemia, can be present for more than a year prior to diagnosis. Close to one half of lesions required either no further intervention or only endoscopic surveillance.

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Prognostic factors for liver metastasis in patients with small intestinal stromal tumor: A retrospective analysis of surveillance, epidemiology, and end results

Liu,

Zhang,

Qiao

et al. 2024

World j. surg.

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BackgroundLiver metastasis (LIM) is the most common distant site of metastasis in small intestinal stromal tumors (SISTs). The aim of this study was to determine the risk and prognostic factors associated with LIM in patients with SISTs.MethodsPatients diagnosed with gastrointestinal stromal tumors between 2010 and 2019 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression models, as well as a Cox regression model were used to explore the risk factors associated with the development and prognosis of LIM. Additionally, the overall survival (OS) of patients with LIM was analyzed using the Kaplan‐Meier method. Furthermore, a predictive nomogram was constructed, and the model's performance was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).ResultsA total of 1582 eligible patients with SISTs were included, among whom 146 (9.2%) were diagnosed with LIM. Poor tumor grade, absence of surgery, later T‐stage, and no chemotherapy were associated with an increased risk of developing LIM. The nomogram prediction model achieved an AUC of 0.810, 95% Confidence Interval (CI) 0.773–0.846, indicating good performance, and the calibration curve showed excellent accuracy in predicting LIM. The OS rate of patients with LIM was significantly lower than that of patients without LIM (p < 0.001).ConclusionsPatients with SISTs who are at high risk of developing LIM deserve more attention during follow‐up, as LIM can significantly affect patient prognosis. The nomogram demonstrated good calibration and discrimination for predicting LIM.

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Advance in diagnosis and treatment of small bowel tumors: a single-center report

Abstract: New development of different endoscopic approaches to the small bowel has led to reach an earlier diagnosis of small-bowel tumors and a preoperative diagnosis with consequent minimally invasive surgical approach.

Cited by 10 publications

References 16 publications

Overtube-assisted enteroscopy and capsule endoscopy for the diagnosis of small-bowel polyps and tumors: a systematic review and meta-analysis

Overtube-assisted enteroscopy and capsule endoscopy for the diagnosis of small-bowel polyps and tumors: a systematic review and meta-analysis

Clinical Features and Management of Small Bowel Masses Detected During Device-Assisted Enteroscopy: A Multi-Center Experience

Prognostic factors for liver metastasis in patients with small intestinal stromal tumor: A retrospective analysis of surveillance, epidemiology, and end results

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