title: Surveillance of small intestinal abnormalities in patients with hepatocellular carcinoma: a prospective capsule endoscopy study.
abstract: BACKGROUND
  Patients with hepatocellular carcinoma (HCC) sometimes suffer from obscure gastrointestinal bleeding. Portal hypertension (PH), common in cirrhosis, induces esophagogastric varices. Because of the location, PH also may influence mucosal abnormalities in the small intestine. The objective of this study is to estimate the prevalence of small intestinal mucosal abnormalities in HCC patients using capsule endoscopy (CE).
  
  
  METHODS
  We prospectively conducted CE in HCC patients, and analyzed the findings in relation to hepatic function, the number and size of HCC tumor and findings obtained by conventional endoscopy.
  
  
  RESULTS
  Thirty-six patients (aged 66.7 ± 7.5 years, 29 men) underwent CE. Abnormal findings in the small bowel were found in 16 patients (44%), angioectasias in eight patients (22%), erosions in five (14%), varices in four (11%), polyps in four (11%), and submucosal tumor in one (3%). The patients with angioectasia had a larger spleen index than the no abnormal lesions group (85.4 ± 15.8 vs 59.0 ± 24.4, P = 0.02). The former group had been more frequently treated for esophageal varices endoscopically (62% vs 15%, P = 0.02). Large HCC nodules seemed more common in the patients with angioectasia than subjects without abnormal lesions (38% vs 5%, P = 0.06). Small intestinal varices also seemed to have a positive association with large HCC. During the follow up after CE, one patient with small intestinal polyps suffered from obscure gastrointestinal bleeding.
  
  
  CONCLUSIONS
  CE revealed that HCC patients frequently have small intestinal mucosal lesions. In particular, small intestinal angioectasia, which may cause obscure gastrointestinal bleeding, seems to be associated with portal hypertension.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. yamada-a@umin.ac.jp
authors.forename: Atsuo
authors.initials: A
authors.lastname: Yamada
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Watabe
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Obi
authors.forename: Takafumi
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kondo
authors.forename: Miki
authors.initials: M
authors.lastname: Ohta
authors.forename: Goichi
authors.initials: G
authors.lastname: Togo
authors.forename: Keiji
authors.initials: K
authors.lastname: Ogura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamaji
authors.forename: Makoto
authors.initials: M
authors.lastname: Okamoto
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000368:Aged; D016888:Angiodysplasia / Q000175:diagnosis / Q000473:pathology; D053704:Capsule Endoscopy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D006975:Hypertension, Portal / Q000473:pathology; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D007417:Intestinal Polyps / Q000175:diagnosis / Q000473:pathology; D007421:Intestine, Small / Q000098:blood supply / Q000473:pathology*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000473:pathology; D011169:Portal Vein / Q000473:pathology; D011446:Prospective Studies; D013927:Thrombosis / Q000175:diagnosis / Q000473:pathology; D014648:Varicose Veins / Q000175:diagnosis / Q000473:pathology