Double-Balloon Enteroscopy and Small Bowel Tumors: A South-European Single-Center Experience

Abstract

Small bowel tumors are rare, accounting for 1-2% of all gastrointestinal neoplasms. We sought to determine the diagnostic and therapeutic impact of double-balloon enteroscopy (DBE) in patients with small bowel tumors. Between January 2005 and March 2008, 78 patients underwent 96 DBE. All nine patients (seven males; mean age 68 +/- 11.3 years) with small bowel tumors were retrospectively reviewed. Clinical presentation was: mid-gastrointestinal bleeding or iron-deficient anemia (55.6%); abdominal pain (22.2%); nausea/vomiting and abdominal distension (22.2%). Five patients had abnormal findings in previous capsule endoscopy and four in previous radiologic examinations. Route of insertion was exclusively oral and abnormal lesions were detected in all patients (jejunum 8; ileum 1). Biopsies were taken in seven patients and provided definitive histological diagnosis in all except one. There were no complications of DBE. Surgical resection took place in eight patients. Final histologic diagnosis were: primary carcinoma (33.3%), gastrointestinal stromal tumor (GIST) (33.3%), malignant lymphoma (22.2%), and carcinoid tumor (11.1%). Mean follow-up time was 15.4 +/- 12.7 months (range 2-34 months). Six patients were submitted to chemotherapy. Two patients died. Small bowel tumors are common in patients submitted to DBE. Given its safety and diagnostic capabilities, DBE should be considered the gold-standard method in the study of these neoplasms.

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

“…10,11,14 Two Portuguese series also support this finding, despite being limited to a smaller sample size. 12,13 In our center, 46% of the patients had distant metastasis/unresectable cancer at diagnosis, contributing, as expected, to a worse outcome. An advanced oncological stage and presenting patterns such as intestinal obstruction, perforation or active bleeding, could explain the low time between symptoms onset and tumor diagnosis described in the results.…”

“…Video capsule endoscopy and balloon assisted enteroscopy (single or double balloon) are examples of those breakthroughs and they provided a considerable advance in both the detection and treatment of small bowel lesions. [10][11][12][13][14] Although publications concerning small bowel tumors and their diagnostic methods have been increasing, the amount of data is still limited, particularly in Portugal. With the present work, we aim to describe the clinical and pathological characteristics of patients diagnosed with malignant small bowel tumors, in a Portuguese single center, and try to establish how these tumors are currently being managed and treated.…”

Multicenter survey on the use of device‐assisted enteroscopy in Portugal

“…25,27 The diagnostic yield for suspected small-bowel tumors (52%) was below the pooled diagnostic yield (p ¼ 0.001). Although DAE is regarded as the gold standard for the diagnosis of small-bowel tumors, 28 this lower diagnostic yield reflects a significant portion of false-positive tumors in CE, probably resulting from bulges due to compressions from adjacent organs or bowel loops. 29 Most examinations were performed under anesthesiologist-administered propofol sedation, a common practice in deep sedation for endoscopic procedures in Portugal.…”

Clinical Characteristics of Small Bowel Tumors Diagnosed by Double-Balloon Endoscopy: KASID Multi-Center Study

“…In the past, the diagnosis of small bowel tumors was made mainly through SBFT, abdominal CT, or even laparotomy; however, more accurate diagnosis for small bowel tumors became possible after the development of CE and DBE. The frequency of small bowel tumors in patients who receive CE has been reported to be 1.6-8.9% [4][5][6][7][8][9][10], while the frequency in patients who receive DBE is 10.0, 11.5 and 13.9% according to studies performed in Germany, Portugal, and Japan, respectively [15][16][17]. This difference is because DBE is usually performed to confirm abnormal findings that have been detected by other imaging studies, including CE.…”