title: Advance in diagnosis and treatment of small bowel tumors: a single-center report.
abstract: BACKGROUND
  The past decade has seen significant advances in the evaluation of the small bowel, long considered as the "black box" in gastroenterology. The development of several endoscopic techniques, including capsule endoscopy (CE) and double (DBE)- and single (SBE)-balloon enteroscopy, has improved the evaluation of this part of the gut and led to reach a more precise preoperative diagnosis of small-bowel tumors. These rare tumors were previously diagnosed only after laparotomy, although laparoscopic advanced surgery can be used for minimally invasive therapeutic approach in these patients. This study was designed to evaluate the diagnostic and therapeutic impact of endoscopic procedures on small-bowel tumors.
  
  
  METHODS
  During October 2010, 148 SBE procedures were performed; in 14 patients (7 males and 7 females, mean age 58.8 years; range 37-82 years) who suffered from obscure gastrointestinal bleeding, with previous negative upper and lower GI endoscopy, a diagnosis of small-bowel tumor was suspected according to CT scan (7 cases) and/or CE (11 patients). Then, an enteroscopy was performed.
  
  
  RESULTS
  Multiple biopsies were taken in 9 cases; endoscopic tattoos were performed in 11 cases. After endoscopic procedures, histological examination showed melanoma in one case, adenocarcinoma in seven, and adenoma in one case. In 11 of 14 patients, a laparoscopic partial resection of small bowel involved was possible due to endoscopic tattoos. In one patient, the involvement of colic segment precluded a laparoscopic resection. In two patients, the laparoscopic resection was not possible for technical problems. Histological findings on resected specimens were indicative for melanoma in one case, gastrointestinal stromal tumor (GIST) in four cases, gastrointestinal autonomic nerve tumor (GANT) in one case, adenoma in one, and adenocarcinoma in seven cases.
  
  
  CONCLUSIONS
  New development of different endoscopic approaches to the small bowel has led to reach an earlier diagnosis of small-bowel tumors and a preoperative diagnosis with consequent minimally invasive surgical approach.
authors: Digestive Endoscopy Unit, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy.
authors: M E
authors: ME
authors: Riccioni
authors: R
authors: R
authors: Cianci
authors: R
authors: R
authors: Urgesi
authors: A
authors: A
authors: Bizzotto
authors: C
authors: C
authors: Spada
authors: G
authors: G
authors: Rizzo
authors: C
authors: C
authors: Coco
authors: G
authors: G
authors: Costamagna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy; D058582:Double-Balloon Enteroscopy; D055088:Early Detection of Cancer; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D007421:Intestine, Small; D007902:Length of Stay; D008297:Male; D008875:Middle Aged