Increased diagnostic yield of small bowel tumors with capsule endoscopy.
BACKGROUND
It is believed that cancers of the small intestine represent <2% of all malignant tumors of the gastrointestinal tract, although the accuracy of this estimate is unknown, because the current methodologies for examining the small bowel have proved inadequate. Capsule endoscopy allows a more detailed inspection of the small intestine and may improve the ability to diagnose small bowel tumors. The objective of this study was to evaluate the effectiveness of capsule endoscopy in diagnosing small bowel tumors and to help establish the true incidence of tumors in obscure gastrointestinal bleeding.


METHODS
A retrospective analysis of the charts of 562 patients who underwent capsule endoscopy from August 2001 to November 2003 for a variety of indications was performed. The indication for the procedure was bleeding (alone or in addition to another indication, such as abnormal imaging) in 443 patients.


RESULTS
A diagnosis was made by capsule endoscopy in 277 patients (49.3%). Of 562 patients who were included in the study, 50 patients (8.9%) were diagnosed with small bowel tumors. The types of tumor diagnosed by capsule endoscopy included 8 adenocarcinomas (1.4%), 10 carcinoids (1.8%), 4 gastrointestinal stromal tumors (0.7%), 5 lymphomas (0.9%), 3 inflammatory polyps, 1 lymphangioma, 1 lymphangioectasia,1 hemangioma, 1 hamartoma, and 1 tubular adenoma. Of the tumors diagnosed, 48% were malignant. It was observed that 9 of 67 patients (13%) younger than age 50 years who underwent capsule endoscopy for obscure bleeding had small bowel tumors. The pathology results were not available for 10 patients.


CONCLUSIONS
Capsule endoscopy diagnosed small bowel tumors in 8.9% of patients who underwent the procedure for a variety of reasons, establishing it as an effective diagnostic modality. This incidence of small bowel tumors suggests an important role for capsule endoscopy in the algorithm for the diagnostic work-up of patients with suspected small bowel lesions. Capsule endoscopy may lead to earlier detection and treatment of small bowel tumors and an improved prognosis for patients with these neoplasms.
Cobrin
Gena M
GM
Division of Gastroenterology, Department of Medicine, The Mount Sinai Medical Center, New York, New York, USA. gcobrin@gidox.com
Pittman
Robert H
RH
Lewis
Blair S
BS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002214:Capsules; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D007421:Intestine, Small / Q000473:pathology*; D007580:Jejunal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013686:Telemetry / Q000295:instrumentation; D014741:Video Recording / Q000295:instrumentation
D002214:Capsules