title: Capsule endoscopy in neoplastic diseases.
abstract: Until recently, diagnosis and management of small-bowel tumors were delayed by the difficulty of access to the small bowel and the poor diagnostic capabilities of the available diagnostic techniques. An array of new methods has recently been developed, increasing the possibility of detecting these tumors at an earlier stage. Capsule endoscopy (CE) appears to be an ideal tool to recognize the presence of neoplastic lesions along this organ, since it is non-invasive and enables the entire small bowel to be visualized. High-quality images of the small-bowel mucosa may be captured and small and flat lesions recognized, without exposure to radiation. Recent studies on a large population of patients undergoing CE have reported small-bowel tumor frequency only slightly above that reported in previous surgical series (range, 1.6%-2.4%) and have also confirmed that the main clinical indication to CE in patients with small-bowel tumors is obscure gastrointestinal (GI) bleeding. The majority of tumors identified by CE are malignant; many were unsuspected and not found by other methods. However, it remains difficult to identify pathology and tumor type based on the lesion's endoscopic appearance. Despite its limitations, CE provides crucial information leading in most cases to changes in subsequent patient management. Whether the use of CE in combination with other new diagnostic (MRI or multidetector CT enterography) and therapeutic (Push-and-pull enteroscopy) techniques will lead to earlier diagnosis and treatment of these neoplasms, ultimately resulting in a survival advantage and in cost savings, remains to be determined through carefully-designed studies.
authors.affiliation: Division of Gastroenterology 2, Department of Gastroenterology and Clinical Nutrition, S. Giovanni A.S. Hospital, Via Cavour 31, Turin 10123, Italy. pennazio.marco@gmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Pennazio
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rondonotti
authors.forename: Roberto
authors.initials: R
authors.lastname: de Franchis
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000175:diagnosis; D053704:Capsule Endoscopy / Q000009:adverse effects; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis*; D044483:Intestinal Polyposis / Q000175:diagnosis; D007421:Intestine, Small; D010580:Peutz-Jeghers Syndrome / Q000175:diagnosis
references.citation: Gastrointest Endosc. 2006 Jul;64(1):66-72
references.pmid: 16813805
references.citation: Gastrointest Endosc. 2006 Nov;64(5):740-50
references.pmid: 17055868
references.citation: World J Surg. 2000 Apr;24(4):421-9
references.pmid: 10706914
references.citation: Cancer Epidemiol Biomarkers Prev. 1998 Mar;7(3):243-51
references.pmid: 9521441
references.citation: Endoscopy. 2004 Dec;36(12):1054-9
references.pmid: 15578294
references.citation: Clin Gastroenterol Hepatol. 2004 Nov;2(11):1010-6
references.pmid: 15551254
references.citation: Gastrointest Endosc. 2005 Nov;62(5):712-6; quiz 752, 754
references.pmid: 16246685
references.citation: Can J Gastroenterol. 2007 Feb;21(2):113-5
references.pmid: 17299616
references.citation: Intern Med. 2007;46(11):705-9
references.pmid: 17541220
references.citation: Eur J Radiol. 2007 May;62(2):160-5
references.pmid: 17344005
references.citation: Gut. 1991 Jul;32(7):763-5
references.pmid: 1855682
references.citation: Endoscopy. 2007 May;39(5):455-8
references.pmid: 17516353
references.citation: Gastrointest Endosc. 2007 Apr;65(4):725-8
references.pmid: 17383473
references.citation: Gastrointest Endosc Clin N Am. 2007 Jan;17(1):169-78, viii-ix
references.pmid: 17397783
references.citation: Gastrointest Endosc Clin N Am. 2004 Jan;14(1):25-31
references.pmid: 15062377
references.citation: Gastrointest Endosc. 2005 Jul;62(1):55-61
references.pmid: 15990820
references.citation: Endoscopy. 2006 Apr;38(4):385-90
references.pmid: 16680639
references.citation: J Magn Reson Imaging. 1996 Nov-Dec;6(6):855-60
references.pmid: 8956128
references.citation: Gastrointest Endosc. 2006 Sep;64(3):445-9
references.pmid: 16923502
references.citation: Am J Gastroenterol. 2006 Oct;101(10):2237-43
references.pmid: 17032187
references.citation: Am J Gastroenterol. 1994 May;89(5):699-701
references.pmid: 8172140
references.citation: Gastrointest Endosc Clin N Am. 1999 Jan;9(1):93-114
references.pmid: 9834319
references.citation: Gastrointest Endosc. 2006 Apr;63(4):660-5
references.pmid: 16564869
references.citation: Endoscopy. 2005 Oct;37(10):1065-7
references.pmid: 16189792
references.citation: Surgery. 1984 Jun;95(6):635-9
references.pmid: 6203181
references.citation: Endoscopy. 2005 Oct;37(10):960-5
references.pmid: 16189768
references.citation: Gastrointest Endosc. 2006 Oct;64(4):530-7
references.pmid: 16996344
references.citation: Clin Radiol. 2007 Jul;62(7):607-14
references.pmid: 17556028
references.citation: J Natl Cancer Inst. 1987 Apr;78(4):653-6
references.pmid: 3470541
references.citation: Am J Gastroenterol. 2005 Jul;100(7):1498-502
references.pmid: 15984971
references.citation: J Clin Gastroenterol. 2001 Oct;33(4):267-82
references.pmid: 11588539
references.citation: Gastrointest Endosc Clin N Am. 2004 Jan;14(1):139-48
references.pmid: 15062387
references.citation: Endoscopy. 2007 Feb;39 Suppl 1:E86-7
references.pmid: 17440873
references.citation: Cancer. 1961 Mar-Apr;14:249-57
references.pmid: 13695582
references.citation: Clin Gastroenterol Hepatol. 2006 Aug;4(8):998-1003
references.pmid: 16814612
references.citation: Endoscopy. 2005 Dec;37(12):1174-80
references.pmid: 16329013
references.citation: Int J Epidemiol. 1993 Apr;22(2):198-206
references.pmid: 8505174
references.citation: JSLS. 2006 Oct-Dec;10(4):496-8
references.pmid: 17575765
references.citation: Arch Surg. 2002 May;137(5):564-70; discussion 570-1
references.pmid: 11982470
references.citation: Endoscopy. 2006 Apr;38(4):408-11
references.pmid: 16680643
references.citation: Dig Dis Sci. 2007 Apr;52(4):1026-30
references.pmid: 17380403
references.citation: J Gastroenterol Hepatol. 2006 May;21(5):922-3
references.pmid: 16704551
references.citation: Lancet. 1978 Jul 29;2(8083):239-41
references.pmid: 79033
references.citation: Eur Radiol. 2002 Nov;12(11):2651-8
references.pmid: 12386753
references.citation: Gastrointest Endosc. 2005 Jan;61(1):140-7
references.pmid: 15672077
references.citation: Dig Liver Dis. 2006 Dec;38(12):867-78
references.pmid: 17045557
references.citation: Arch Pathol Lab Med. 2006 Oct;130(10):1466-78
references.pmid: 17090188
references.citation: Histopathology. 2005 Nov;47(5):467-78
references.pmid: 16241994
references.citation: Histopathology. 1998 Feb;32(2):116-25
references.pmid: 9543667
references.citation: Endoscopy. 2005 Oct;37(10):1008-17
references.pmid: 16189776
references.citation: Am J Gastroenterol. 2005 Jan;100(1):27-37
references.pmid: 15654777
references.citation: Cancer Epidemiol Biomarkers Prev. 1996 Feb;5(2):81-4
references.pmid: 8850266
references.citation: J Clin Gastroenterol. 2006 Sep;40(8):688-91
references.pmid: 16940879
references.citation: J Clin Gastroenterol. 2007 Jul;41(6):576-82
references.pmid: 17577114
references.citation: Arch Surg. 2007 Mar;142(3):229-35
references.pmid: 17372046
references.citation: Cancer. 2006 Jul 1;107(1):22-7
references.pmid: 16736516
references.citation: Surg Endosc. 2007 Oct;21(10):1776-80
references.pmid: 17356941
references.citation: Am J Gastroenterol. 2006 Sep;101(9):2016-24
references.pmid: 16968508
references.citation: Am J Gastroenterol. 2007 Jun;102(6):1204-8
references.pmid: 17324125
references.citation: Dig Dis. 1996 Jul-Aug;14(4):245-57
references.pmid: 8843980
references.citation: Arch Surg. 1964 Jun;88:969-73
references.pmid: 14132002
references.citation: Br J Cancer. 1991 Jan;63(1):143-5
references.pmid: 1989654
references.citation: Endoscopy. 2007 Feb;39 Suppl 1:E41
references.pmid: 17285490
references.citation: Int J Epidemiol. 1996 Aug;25(4):722-8
references.pmid: 8921448
references.citation: Semin Oncol. 1988 Apr;15(2):116-28
references.pmid: 3285475