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The incidence of small bowel tumors is increasing over time.
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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.
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Dedicated small bowel cross-sectional imaging techniques have a key role in both diagnosis and preoperative staging of small bowel tumors.
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Device-assisted enteroscopy (DAE) provides definitive diagnosis by allowing collection of tissue samples; moreover, by
Neoplastic Diseases of the Small Bowel
Section snippets
Key points
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bowel barium follow-through studies were once the mainstay of small bowel imaging, but these have now largely been superseded by dedicated small bowel cross-sectional imaging techniques, namely magnetic resonance (MR) and CT.59 Because collapsed bowel loops can hide lesions or may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.
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2022, Digestive and Liver DiseaseCitation 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.
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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.