Small Bowel Tumors Discovered During Double-Balloon Enteroscopy

Cangemi, David; Patel, Mihir; Gómez, Victoria; Cangemi, John R.; Stark, Mark E.; Lukens, Frank

doi:10.1097/mcg.0b013e318281a44e

Cited by 47 publications

(12 citation statements)

References 14 publications

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“…Ectopic gastric and pancreatic tissues frequently found in the diverticulum are the primary causes of gastrointestinal bleeding, because highly acidic secretions from gastric tissues and alkaline secretions from pancreatic tissues cause ulcerations of the adjacent normal ileal mucosa [7]. With regard to the incidence of small bowel tumors, according to a report of analysis of a prospectively collected database of double-balloon enteroscopy, of the 1106 patients who underwent double-balloon enteroscopy procedures, 134 (12.1 %) were reported to have a small bowel tumor, of whom 36 (26.9 %) had obscure gastrointestinal bleeding and 20 (14.9 %) had overt gastrointestinal bleeding [8]. Sometimes, Meckel’s diverticulum may present as an intraluminal polypoid mass causing small bowel obstruction when the diverticulum is inverted into the ileum.…”

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confidence: 99%

Intestinal hemorrhage caused by Meckel’s diverticulum with ectopic gastric mucosa on polypoid lesion: a case report

et al. 2016

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Meckel’s diverticulum may sometimes present as an intraluminal polypoid mass causing small bowel obstruction; however, gastrointestinal bleeding due to Meckel’s diverticulum with a polypoid lesion is rare. A 14-year-old girl presented with tarry stool and syncope in our hospital. Laboratory examination showed iron-deficiency anemia with a low hemoglobin level of 5.8 g/dl. The bleeding site was detected by neither upper gastrointestinal endoscopy nor colonoscopy. Transanal double-balloon enteroscopy showed a diverticulum with an ulceration at a site approximately 50 cm from the ileocecal valve and a polypoid lesion inside of the diverticulum. Histopathological examination of a polypoid lesion revealed an ectopic gastric mucosa of the fundic type. Furthermore, technetium-99m pertechnetate scintigraphy showed a hot spot in her lower right abdomen. On the basis of these findings, she was diagnosed as having hemorrhagic Meckel’s diverticulum. Single-incision laparoscopy-assisted segmental bowel resection of the ileum was performed. The patient recovered well, and she was discharged from the hospital on postoperative day 7. She was doing well 6 months later without evidence of reoccurrence. In this report, we describe a case of Meckel’s diverticulum with a polypoid lesion; hemorrhage may have occurred owing to the ulceration of the ileal mucosa with which the polypoid lesion directly came in contact. We consider this case to be of interest to gain insight into the site and mechanism of ulceration associated with Meckel’s diverticulum.

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Section: Discussionmentioning

confidence: 99%

Intestinal hemorrhage caused by Meckel’s diverticulum with ectopic gastric mucosa on polypoid lesion: a case report

et al. 2016

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“…The study from the United States showed that carcinoid tumor is the most common SBTs rather than adenocarcinoma [ 24 ]. Cangemi et al reported that the most common SBT was carcinoid tumor (19.4%) followed by GIST and lymphoma [ 25 ]. They also reported that hamartoma (10.4%) was the most common benign tumor, followed by inflammatory polyps and adenoma.…”

Section: Discussionmentioning

confidence: 99%

“…The most common location of SBTs is the ileum in a previous study of the United States [ 25 ]. Our study found that the distribution of SBTs is similar to that of a previous Korean study, which reported that SBTs were most frequently located in the jejunum (61.7%), followed by ileum (34.9%) and duodenum (16.1%) [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy of Various Diagnostic Tests for Small Bowel Tumors and Clinical Features of Tumors Missed by Capsule Endoscopy

Han

Hong

Jang

et al. 2015

Gastroenterology Research and Practice

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Background. We aimed to evaluate the efficacy of various diagnostic tools such as computerized tomography (CT), small bowel follow-through (SBFT), and capsule endoscopy (CE) in diagnosing small bowel tumors (SBTs). Additionally, we aimed to evaluate the clinical features of SBTs missed by CE. Methods. We retrospectively studied 79 patients with histologically proven SBT. Clinical data were analyzed with particular attention to the efficacy of CT, SBFT, and CE in detecting SBT preoperatively. We also analyzed the clinical features of SBTs missed by CE. Results. The most common symptoms of SBT were bleeding (43%) and abdominal pain (13.9%). Diagnostic yields were as follows: CT detected 55.8% of proven SBTs; SBFT, 46.1%; and CE, 83.3%. The sensitivity for detecting SBTs was 40.4% for CT, 43.9% for SBFT, and 79.6% for CE. Two patients with nondiagnostic but suspicious findings on CE and seven patients with negative findings on CE were eventually found to have SBT. These nine patients were eventually diagnosed with gastrointestinal stromal tumor (4), small polyps (3), inflammatory fibroid polyp (1), and adenocarcinoma (1). These tumors were located in the proximal jejunum (5), middle jejunum (1), distal jejunum (1), and proximal ileum (1). Conclusion. CE is more efficacious than CT or SBFT for detecting SBTs. However, significant tumors may go undetected with CE, particularly when located in the proximal jejunum.

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“…In addition, the risk of retention is still present, although the incidence is low (1.5% to 5%) [17,18] .Therefore, the retention risk should be assessed and informed to the patients before the procedure [19,20] . Second, it is difficult for CE to differentiate the elevated submucosal lesions without erosions or ulcers on the surface from the external pressure [21,22] . At that time, DBE is usually necessary to differentiate the lesions.…”

Section: Discussionmentioning

confidence: 99%

Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases

Zhang¹,

Chun-hua²,

Li³

2015

WJG

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AIM:To compare the roles of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in the diagnosis of obscure small bowel diseases. December 2014, 88 patients were included in this study; the patients had undergone gastroscopy, colonoscopy, radiological small intestinal barium meal, abdominal computed tomography or magnetic resonance imaging scan and mesenteric angiography, but their diagnoses were still unclear. The patients with gastrointestinal obstructions, fistulas, strictures, or cardiac pacemakers, as well as pregnant women, and individuals who could not accept the capsule-retention or capsule-removal surgery were excluded. Patients with heart, lung and other vital organ failure diseases were also excluded. Everyone involved in this study had undergone CE and DBE. The results were divided into: (1) the definite diagnosis (the diagnosis was confirmed at least by one of the biopsy, surgery, pathology or the drug treatment effects with follow-up for at least 3 mo); (2) the possible diagnosis (a possible diagnosis was suggested by CE or DBE, but not confirmed by the biopsy, surgery or follow-up drug treatment effects); and (3) the unclear diagnosis (no exact causes were provided by CE and DBE for the disease). The detection rate and the diagnostic yield of the two methods were compared. in the etiologies between CE and DBE was estimated, and the different possible etiologies caused by the age groups were also investigated. METHODS: From June 2009 toRESULTS: CE exhibited a better trend than DBE for diagnosing scattered small ulcers (P = 0.242, Fisher' s test), and small vascular malformations (χ 2 = 1.810, P = 0.179, Pearson χ 2 test), but with no significant differences, possible due to few cases. However, DBE was better than CE for larger tumors (P = 0.018, Fisher's test) and for diverticular lesions with bleeding ulcers (P = 0.005, Fisher's test). All three hemangioma cases diagnosed by DBE in this study (including sponge hemangioma, venous hemangioma, and hemangioma with hamartoma lesions) were all confirmed by biopsy. Two parasite cases were found by CE, but were negative by DBE. This study revealed no obvious differences in the detection rates (DR) of CE (60.0%, 53/88) and DBE (59.1%, 52/88). However, the etiological diagnostic yield (DY) difference was apparent. The CE diagnostic yield was 42.0% (37/88), and the DBE diagnostic yield was 51.1% (45/88). Furthermore, there were differences among the age groups (χ 2 = 22.146, P = 0.008, Kruskal Wallis Test). Small intestinal cancer (5/6 cases), vascular malformations (22/29 cases), and active bleeding (3/4 cases) appeared more commonly in the patients over 50 years old, but diverticula with bleeding ulcers were usually found in the 15-25-year group (4/7cases). The over-25-year group accounted for the stromal tumors (10/12 cases).CONCLUSION: CE and DBE each have their own advantages and disadvantages. The appropriate choice depends on the patient's age, tolerance, and clinical manifestations. Sometimes CE followed by DBE is necessary. Core t...

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Small Bowel Tumors Discovered During Double-Balloon Enteroscopy

Cited by 47 publications

References 14 publications

Intestinal hemorrhage caused by Meckel’s diverticulum with ectopic gastric mucosa on polypoid lesion: a case report

Intestinal hemorrhage caused by Meckel’s diverticulum with ectopic gastric mucosa on polypoid lesion: a case report

Clinical Efficacy of Various Diagnostic Tests for Small Bowel Tumors and Clinical Features of Tumors Missed by Capsule Endoscopy

Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases

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