The role of pre‐operative imaging and double balloon enteroscopy in the surgical management of small bowel neuroendocrine tumors: Is it necessary?

Manguso, Nicholas; Gangi, Afshin; Johnson, Jeffrey; Harit, Attiya; Nissen, Nicholas N.; Jamil, Laith H.; Lo, Simon K.; Wachsman, Ashley; Hendifar, Andrew Eugene; Amersi, Farin

doi:10.1002/jso.24825

Cited by 25 publications

(20 citation statements)

References 33 publications

(40 reference statements)

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“…They demonstrate that all these diagnostic modalities are complementary in the management of patients with small-bowel disorders, such as inflammatory bowel disease and small-bowel tumors [82 -85]. An SBCE and dedicated small-bowel imaging (for example in the case of small-bowel tumors and strictures) helps to determine the best route of approach for DAE to maximize the chances of reaching the previously identified small-bowel pathology [34,86]. Dedicated small-bowel cross-sectional imaging can also give information on the number of lesions, mural and extramural pathology, and vascularity of any lesion.…”

Section: Recommendationmentioning

confidence: 99%

“…In the case of small-bowel strictures, DAE is indicated for a histological diagnosis, endoscopic balloon dilation of the stenosis, or retrieval of a retained small-bowel capsule [113 -115]. Histological diagnosis of suspected small-bowel tumors is another indication for DAE [86]. A submucosal tattoo can be placed to help guide surgical resection of a tumor [36].…”

Section: Recommendationmentioning

confidence: 99%

“…The management of such patients may include repeat DAE with APC, in conjunction with iron therapy and pharmacotherapy, such as somatostatin analogues in those who have refractory anemia [127,141,142]. Patients with small-bowel tumors without metastatic disease should be considered for surgery after discussion at appropriate MDTs [86,143]. Patients with small-bowel strictures might need repeated endoscopic balloon dilation or surgery, depending on their response to endoscopic balloon dilation and the number of strictures they have [144,145].…”

Section: Recommendationmentioning

confidence: 99%

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Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

et al. 2020

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Main RecommendationsThe European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize training in small-bowel endoscopy across European centers. The following criteria and framework for training in small-bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE), which aim to provide uniform and high quality training to ensure that small-bowel endoscopists are competent to operate independently, are based on the current literature and experience of experts in the field. Three main areas are covered: skills required prior to commencing training in small-bowel endoscopy; structured training for trainees to become independent endoscopists; and ways of ensuring competence is achieved. 1 Centers providing training in SBCE should perform a minimum of 75 – 100 SBCEs/year. 2 Experience in bidirectional endoscopies is desirable for structured training in SBCE. 3 SBCE courses should consist of at least 50 % hands-on training and cover information on technology, indications and contraindications for SBCE, pathologies that can be encountered on SBCE, and standard terminology that should be used during reporting of SBCE. An SBCE course should be completed prior to achieving competence in SBCE reporting. 4 Competence in SBCE can be assessed by considering a minimum of 30 SBCEs. Direct Observation of Procedural Skills, short SBCE videos, and multiple-choice questions can be useful to assess improvement in the skills of trainees. 5 Centers offering training in DAE should aim to carry out at least 75 DAEs/year, should have direct links with an SBCE service, and should allow regular discussion of cases at a radiology small-bowel MDT. Training centers with lower numbers are encouraged to offer training by “buddying-up” with other centers, or using mentoring systems. 6 DAE trainees must be independent in bidirectional endoscopies and have experience in level 1 polypectomy prior to commencement of training. They should also be competent in reviewing SBCEs. 7 Training in DAE should be structured with a minimum of 75 procedures, including 35 retrograde DAEs, with therapeutic procedures undertaken in at least 50 % of the DAEs performed. Training should cover the indications, contraindications, complications including prevention, and technicalities of the DAE procedure; formal evaluation should follow. DAE trainees must acquire skills to independently manage and advise on small-bowel pathology following DAE procedures. 8 It is highly recommended that international societies develop online modules and courses on DAE, which are currently lacking across Europe.

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Section: Recommendationmentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

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Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

et al. 2020

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“…CT and MRI can miss SBT 35. The DY of SBCE is reported to be higher than that of CT in some studies 36.…”

Section: Sb Tumoursmentioning

confidence: 96%

Optimising the use of small bowel endoscopy: a practical guide

Zammit

Sanders

McAlindon

et al. 2019

Frontline Gastroenterol

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The wireless nature of capsule endoscopy offers patients the least invasive option for small bowel investigation. It is now the first-line test for suspected small bowel bleeding. Furthermore meta-analyses suggest that capsule endoscopy outperforms small bowel imaging for small bowel tumours and is equivalent to CT enterography and magnetic resonance enterography for small bowel Crohn’s disease. A positive capsule endoscopy lends a higher diagnostic yield with device-assisted enteroscopy. Device-assisted enteroscopy allows for the application of therapeutics to bleeding points, obtain histology of lesions seen, tattoo lesions for surgical resection or undertake polypectomy. It is however mainly reserved for therapeutics due to its invasive nature. Device-assisted enteroscopy has largely replaced intraoperative enteroscopy. The use of both modalities is discussed in detail for each indication. Current available guidelines are compared to provide a concise review.

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“…CE should be the endoscopic method of choice in order to guide the route of DAE ( 78 - 80 ). DAE should be preferentially performed in patients with previous positive exams, for biopsies sampling, and marking the exact location of the lesion ( 81 - 84 ) ( Figure 5 ).…”

Section: Malignant Tumorsmentioning

confidence: 99%

Impact of enteroscopy on diagnosis and management of small bowel tumors

Safatle‐Ribeiro

Ribeiro

2020

Chinese Journal of Cancer Research

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Small bowel tumors (SBTs) have been increasingly diagnosed in recent decades. The pathogenesis of this increment is largely unknown, but advances in radiological and endoscopic methods facilitate the improvement of the diagnosis. Capsule endoscopy (CE) and device-assisted enteroscopy (DAE) allow the clinician to assess the entire small bowel in the search for suspicious lesions, or a cause of symptoms. In this review, we discuss the role of enteroscopy, techniques and strategies in the diagnosis and management of SBTs, and a brief description of the most common tumors.

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The role of pre‐operative imaging and double balloon enteroscopy in the surgical management of small bowel neuroendocrine tumors: Is it necessary?

Abstract: Most SBNETs are identified with a combination of imaging modalities. In those with unidentified primary tumors after imaging, DBE should be considered as it may provide valuable information as to the location of the primary tumor.

Cited by 25 publications

References 33 publications

Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Curriculum for small-bowel capsule endoscopy and device-assisted enteroscopy training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Optimising the use of small bowel endoscopy: a practical guide

Impact of enteroscopy on diagnosis and management of small bowel tumors

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