Double Balloon Enteroscopy Detects Small Bowel Mass Lesions Missed by Capsule Endoscopy

Ross, Andrew; Mehdizadeh, Shahab; Tokar, Jeffrey L.; Leighton, Jonathan A.; Kamal, Ahmad; Chen, Ann; Schembre, Drew; Chen, Gary; Binmoeller, Kenneth F.; Kozarek, Richard A.; Waxman, Irving; Dye, Charles; Gerson, Lauren B.; Harrison, M. Edwyn; Haluszka, Oleh; Lo, Simon K.; Semrad, Carol E.

doi:10.1007/s10620-007-0110-0

Cited by 189 publications

(117 citation statements)

References 18 publications

(22 reference statements)

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“…Bellutti and coworkers reported a diagnostic yield of DBE for primary tumor search in patients with metastatic or suspected NET of 33%, that is, inferior to the one achieved in our study by means of WCE [8]. Moreover, other studies evaluated the diagnostic yield of WCE and DBE at detecting small bowel mass lesions responsible for OGIB, reporting divergent findings [9,10]. In our Institution, PillCam SB1 system was used on 5 cases, whereas the remaining 19 subjects underwent videocapsule endoscopy by means of the PillCam SB2 system.…”

Section: Discussioncontrasting

confidence: 71%

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

Furnari

Buda²,

Delconte

et al. 2017

JGLD

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Background & Aims: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumor in patients showing liver NET metastases when first-line investigations are inconclusive.Method: Twenty-four patients with histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration.Results: Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded.Conclusions: Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.Abbreviations: DBE: double balloon enteroscopy; GEP-NET: gastro-entero-pancreatic neuroendocrine tumor; GI: gastrointestinal; ENETS: European Neuroendocrine Tumor Society; NET: neuroendocrine tumor; SSRS: somatostatin receptor scintigraphy; WCE: wireless capsule endoscopy.

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Section: Discussioncontrasting

confidence: 71%

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

Furnari

Buda²,

Delconte

et al. 2017

JGLD

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“…Although it is a minimally invasive test, capsule endoscopy enables the diagnosis of various disorders of the small intestine, such as vascular abnormalities, ulcerative lesions, and tumors [4][5][6][7][8][9][10]. However, false positive or false negative results for small bowel tumors are limitations of capsule endoscopy [11][12][13], and capsule retention occasionally occurs. Moreover, histologic confirmation is not available for capsule endoscopy.…”

Section: Introductionmentioning

confidence: 99%

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

Lee

Choi

et al. 2011

Dig Dis Sci

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Background Small bowel tumors are relatively rare, and their confirmative diagnosis before surgery is not easy. Aims This study was performed to investigate the clinical characteristics of patients with small bowel tumors who received double-balloon enteroscopy (DBE). Secondary end points were to evaluate the usefulness and safety of DBE for the diagnosis of patients with suspected SB tumors derived from other previous procedures. Methods We retrospectively analyzed consecutive DBE examinations to explore the small intestine in eight university hospitals over a 5-year period. Results A total of 877 DBE examinations (per oral 487, per anal 390) were performed in 645 patients (405 males, mean age 48.2 years). Small bowel tumors were diagnosed in 112 patients (17.4%), of which 38 patients had benign polyps, 29 had gastrointestinal stromal tumors/leiomyomata, 18 had lymphomas, 14 had adenocarcinomas, five had metastatic or invasive cancers, five had lipomas, and three patients had cystic tumors. The main reasons for DBE among patients with small bowel tumors were obscure gastrointestinal bleeding (OGIB, 40.2%) followed by abnormal imaging study (25.2%). The concordance rate of diagnoses based on DBE with diagnoses based on small bowel follow-through, CT, and capsule endoscopy among patients with small bowel tumors was 68.9% (42/61), 75.3% (70/93), and 78.3% (18/23), respectively. Therapeutic plans were changed due to the DBE results in 64.2% of patients with small bowel tumors. Conclusions Approximately one-sixth of patients who received DBE had small bowel tumors, and the most common reason for DBE among patients with small bowel tumors was OGIB. DBE is a useful method for the 123Dig Dis Sci (2011) 56:2920-2927 DOI 10.1007/s10620-011-1839 confirmative diagnosis of small bowel tumors and has a good clinical impact on therapeutic plans and short-term clinical results.

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“…However, this beneficial effect seems to fade on the long-term as new bleeding sources (mainly angiodysplasias) may rise. Moreover, the possibility of false negative VCE should not be ignored (44). Potential bleeding recurrence manifesting as change from occult to overt presentation or ≥4 g/dL drop in hemoglobin, should prompt a "second-look" VCE investigation as acknowledged by current ESGE guidelines (14).…”

Section: Re-bleeding Rate After Index Vce Small Bowel Examinationmentioning

confidence: 99%

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

et al. 2017

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Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of all gastrointestinal (GI) hemorrhages. It usually arises from a small bowel lesion beyond the reach of conventional endoscopy including esophagogastroduodenoscopy and colonoscopy. Video capsule endoscopy (VCE) revolutionized the evaluation of OGIB patients since it allows reliable and noninvasive visualization of the small bowel mucosal surface. Since 2001, VCE has evolved into an efficient technology integrated in clinical practice. It is the cornerstone in the algorithm of OGIB investigation given its high diagnostic yield, which compares favorably to that of double-balloon enteroscopy (DBE). In terms of outcomes, a positive index VCE examination usually correlates to a high re-bleeding rate, while a negative one provides adequate evidence of low re-bleeding risk, suggesting a wait and watch approach in this subset of patients. Additionally, a variety of factors has been acknowledged as significant predictors of re-bleeding episodes. While research data regarding immediate endoscopic findings have matured, data concerning the clinical utility of VCE in patients with OGIB on the long-term remain sparse. This manuscript reviews the current literature, aiming to highlight the role of VCE in the long-term management of OGIB.

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Double Balloon Enteroscopy Detects Small Bowel Mass Lesions Missed by Capsule Endoscopy

Abstract: Double balloon enteroscopy detects small bowel mass lesions responsible for OGIB that are missed by CE. Additional endoscopic evaluation of the small bowel by DBE or intraoperative enteroscopy should be performed in patients with ongoing OGIB and negative or non-specific findings on CE.

Cited by 189 publications

References 18 publications

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

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

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

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