Neoplastic Diseases of the Small Bowel

https://doi.org/10.1016/j.giec.2016.08.005Get rights and content

Section snippets

Key points

  • The incidence of small bowel tumors is increasing over time.

  • Due to its ability to inspect the entire small bowel in a noninvasive manner, capsule endoscopy (CE) is an ideal diagnostic tool when a nonobstructing small bowel tumor is suspected.

  • Dedicated small bowel cross-sectional imaging techniques have a key role in both diagnosis and preoperative staging of small bowel tumors.

  • Device-assisted enteroscopy (DAE) provides definitive diagnosis by allowing collection of tissue samples; moreover, by

Small bowel capsule endoscopy

The detection rate of small bowel tumors via CE ranges from 1.5% to 9%34, 35 and from 3% to 5% in studies collecting more than 1000 patients.36, 37, 38, 39 The rate of small bowel tumors has increased in patients undergoing CE for obscure GI bleeding.36, 37, 38 Among them, the detection of tumors is higher in those presenting with obscure-overt bleeding and in those under the age of 50. Although vascular lesions are the most common finding in older patients, in younger patients, small bowel CE

Dedicated small bowel cross-sectional radiologic imaging

Small bowel barium follow-through studies were once the mainstay of small bowel imaging, but these have now largely been superseded by dedicated small bowel cross-sectional imaging techniques, namely magnetic resonance (MR) and CT.59 Because collapsed bowel loops can hide lesions or may mimic small bowel diseases, both techniques require luminal distension of the intestinal loops to identify small bowel lesions. This is achieved by administering luminal contrast agents.

Two types of oral

Device-assisted enteroscopy

The rate of small bowel tumors diagnosed in patients undergoing DAE for mixed clinical indications is approximately 10% (Table 1).32, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96 Nevertheless, there is wide variability amongst studies (range 3%–20%). The variability depends on several factors. First, the articles from Eastern countries report a higher rate of small bowel tumors (approximately und 15%), as also observed in CE studies.51 This likely reflects different patient selection

Small bowel tumors diagnostic work-up: from evidence to clinical practice

Given the results of clinical studies and limitations of the individual diagnostic tools, the available evidence highlights that the diagnostic tests described in this review are, in the setting of patients with small bowel tumors, absolutely complementary, rather than alternative. In this setting, the result of a single test is often insufficient for establishing a definite diagnosis or ruling out the presence of small bowel tumor. Conversely, a reasoned and balanced combination of the

Acknowledgments

We sincerely thank Stephen Glancy (Department of Radiology, Western General Hospital, Edinburgh, Scotland) and Panagiota Demosthenous (Department of Electrical and Computer Engineering, University of Cyprus, Cyprus) for their contributions to this article.

First page preview

First page preview
Click to open first page preview

References (110)

  • L.R. Shyung et al.

    Proposed scoring system to determine small bowel mass lesions using capsule endoscopy

    J Formos Med Assoc

    (2009)
  • E. Rondonotti et al.

    Utility of 3-dimensional image reconstruction in the diagnosis of small-bowel masses in capsule endoscopy (with video)

    Gastrointest Endosc

    (2014)
  • A. Van Gossum

    Image-enhanced capsule endoscopy for characterization of small bowel lesions

    Best Pract Res Clin Gastroenterol

    (2015)
  • C.B. Ryu et al.

    Mo1670 Does Capsule Endoscopy With Alice Improves Visibility of Small Bowel Lesions?

    Gastrointest Endosc

    (2013)
  • G.A. Zamboni et al.

    CT enterography

    Gastrointest Endosc Clin N Am

    (2010)
  • K. Mitsui et al.

    Role of double-balloon endoscopy in the diagnosis of small bowel tumors: the first Japanese multicenter study

    Gastrointest Endosc

    (2009)
  • I.A. Cazzato et al.

    Diagnostic and therapeutic impact of double-baloon enteroscopy in a series of 100 patients with suspected small bowel lesions

    Dig Liv Dis

    (2007)
  • S.R. Hegde et al.

    double balloon enteroscopy in the elderly: safety, findings, and diagnostic and therapeutic success

    Gastrointest Endosc

    (2010)
  • D. Morgan et al.

    Spiral enteroscopy: prospective U.S. multicenter study in patients with small-bowel disorders

    Gastrointest Endosc

    (2010)
  • M. Manno et al.

    Diagnostic and therapeutic yield of single balloon enteroscopy inpatients with suspected small-bowel disease: results of the Italian multicenter study

    Dig Liv Dis

    (2013)
  • D. Chavalitdhamrong et al.

    Complications of enteroscopy: how to avoid them and manage them when they arise

    Gastrointest Endosc Clin N Am

    (2015)
  • A.I. Neugut et al.

    The epidemiology of cancer of the small bowel

    Cancer Epidemiol Biomarkers Prev

    (1998)
  • J.A. Di Sario et al.

    Small bowel cancer: epidemiological and clinical characteristics from a population-based registry

    Am J Gastroenterol

    (1994)
  • B.G. O’Riordan et al.

    Small bowel tumors: an overview

    Dig Dis Sci

    (1996)
  • S.Y. Pan et al.

    Epidemiology of cancer oft he small intestine

    World J Gastroint Onc

    (2011)
  • National Cancer Institute. SEER stat fact sheets: small intestine cancer. Available at:...
  • R.K. Ross et al.

    Epidemiology of adenocarcinomas of the small intestine: is bile a small bowel carcinogen?

    Br J Cancer

    (1991)
  • N.S. Weiss et al.

    Incidence of histologic types of cancer of the small intestine

    J Natl Cancer Inst

    (1987)
  • S. Gabos et al.

    Small bowel cancer in western Canada

    Int J Epidemiol

    (1993)
  • J.S. Chow et al.

    A population-based study of the incidence of malignant small bowel tumours: SEER, 1973-1990

    Int J Epidemiol

    (1996)
  • R.K. Severson et al.

    Increasing incidence of adenocarcinomas and carcinoid tumors of the small intestine in adults

    Cancer Epidemiol Biomarkers Prev

    (1996)
  • I. Hatzaras et al.

    Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the Connecticut tumor registry

    Arch Surg

    (2007)
  • D.K. Blanchard et al.

    Tumors of the Small Intestine

    World J Surg

    (2000)
  • T. Haselkorn et al.

    Incidence of small bowel cancer in the United States and worldwide: geographic, temporal, and racial differences

    Cancer Causes Control

    (2005)
  • L.G. Shack et al.

    Small intestinal cancer in England & Wales and Scotland: time trends in incidence, mortality and survival

    Aliment Pharmacol Ther

    (2006)
  • C. Lepage et al.

    Incidence and management of primary malignant small bowel cancers: a well-defined French population study

    Am J Gastroenterol

    (2006)
  • R.D. Bojesen et al.

    Incidence of, phenotypes of and survival from small bowel cancer in Denmark, 1994-2010: a population-based study

    J Gastroenterol

    (2016)
  • A. Wolk et al.

    A prospective study of obesity and cancer risk (Sweden)

    Cancer Causes Control

    (2001)
  • C. Samanic et al.

    Obesity and cancer risk among white and black United States veterans

    Cancer Causes Control

    (2004)
  • C.C. Chen et al.

    Risk factors for adenocarcinomas and malignant carcinoids of the small intestine: preliminary findings

    Cancer Epidemiol Biomarkers Prev

    (1994)
  • A.H. Wu et al.

    Smoking, alcohol use, dietary factors and risk of small intestinal adenocarcinoma

    Int J Cancer

    (1997)
  • L. Kaerlev et al.

    The importance of smoking and medical history for development of small bowel carcinoid tumor: a European population-based case-control study

    Cancer Causes Control

    (2002)
  • S.R. Hamilton et al.

    World health organization classification of tumours. Pathology and genetics of tumours of the digestive system

    (2000)
  • T.J. Wu et al.

    Prognostic factors of primary small bowel adenocarcinoma: univariate and multivariate analysis

    World J Surg

    (2006)
  • M.S. Talamonti et al.

    Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management

    Arch Surg

    (2002)
  • S. George et al.

    The role of imatinib plasma level testing in gastrointestinal stromal tumor

    Cancer Chemother Pharmacol

    (2011)
  • M. Essat et al.

    Imatinib as adjuvant therapy for gastrointestinal stromal tumors: a systematic review

    Int J Cancer

    (2011)
  • H. Cardoso et al.

    Malignant small bowel tumors: diagnosis, management and prognosis

    Acta Med Port

    (2015)
  • G.M. Cobrin et al.

    Increased diagnostic yield of small bowel tumors with capsule endoscopy

    Cancer

    (2006)
  • D. Urbain et al.

    Video capsule endoscopy in small-bowel malignancy: a multicenter Belgian study

    Endoscopy

    (2006)
  • Cited by (16)

    • Score reproducibility and reliability in differentiating small bowel subepithelial masses from innocent bulges

      2022, Digestive and Liver Disease
      Citation Excerpt :

      Malignant tumours include neuroendocrine tumour, adenocarcinoma, lymphoma, and sarcoma in order of frequency. Skin melanoma, colorectal cancer, prostate cancer, lung and breast cancers are the common origins of metastatic SB tumours [3]. Though VCE has increased our ability in diagnosing SB pathologies, there are still quite a few limitations, and these arise mainly due to the inability to control the capsule and insufflate the SB.

    • Cancer of the Small Bowel

      2019, Abeloff’s Clinical Oncology
    • Capsule endoscopy in digestive diseases

      2018, FMC Formacion Medica Continuada en Atencion Primaria
    • Current Trends in Capsule Endoscopy

      2022, Small Intestine Disease: A Comprehensive Guide to Diagnosis and Management
    View all citing articles on Scopus

    Disclosure Statements: All the authors do not declare any commercial or financial conflict of interest and any funding sources related to this work.

    Author Contribution: E. Rondonotti, D.E. Yung, S.N. Reddy, J. Georgoiu, and A. Koulaouzids substantially contributed to the article conception and drafted the article; M. Pennazio supervised the work and revised it critically for important intellectual content. All the authors approved the final version to be published.

    View full text