title: Role of double-balloon enteroscopy in malignant small bowel tumors.
abstract: OBJECTIVE
  To assess the double-balloon enteroscopy (DBE) role in malignant small bowel tumors (MSBT).
  
  
  METHODS
  This is a retrospective descriptive study performed in a single center. All consecutive patients who underwent a DBE with final diagnosis of a malignant neoplasm from 2004 to 2014 in our referral center were included. Patient demographic and clinical pathological characteristics were recorded and reviewed. MSBT diagnosis was achieved either by DBE directed biopsy with multiple tissue sampling, endoscopic findings or histological analysis of surgical specimen. We have analyzed double-balloon enteroscopy impact in outcome and clinical course of these patients.
  
  
  RESULTS
  Of 627 patients, 28 (4.5%) (mean age = 60 ± 17.3 years) underwent 30 procedures (25 anterograde, 5 retrograde) and were diagnosed of a malignant tumor. Patients presented with obscure gastrointestinal bleeding (n = 19, 67.9%), occlusion syndrome (n = 7, 25%) and diarrhea (n = 1, 3.6%). They were diagnosed by DBE biopsy (n = 18, 64.3%), histological analysis of surgical specimen (n = 7, 25%) and unequivocal endoscopic findings (n = 2, 7.1%). Gastrointestinal stromal tumor (n = 8, 28.6%), adenocarcinoma (n = 7, 25%), lymphoma (n = 4, 14.3%), neuroendocrine tumor (n = 4, 14.3%), metastatic (n = 3, 10.7%) and Kaposi sarcoma (n = 1, 3.6%) were identified. DBE modified outcome in 7 cases (25%), delaying or avoiding emergency surgery (n = 3), modifying surgery approach (n = 2) and indicating emergency SB partial resection instead of elective approach (n = 2).
  
  
  CONCLUSIONS
  DBE may be critical in the management of MSBT providing additional information that may be decisive in the clinical course of these patients.
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Enrique Pérez-Cuadrado
authors.initials: EP
authors.lastname: Robles
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Pilar Esteban
authors.initials: PE
authors.lastname: Delgado
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Paloma Bebia
authors.initials: PB
authors.lastname: Conesa
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Blanca Martínez
authors.initials: BM
authors.lastname: Andrés
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Milivoj Franulic
authors.initials: MF
authors.lastname: Guggiana
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Eduardo Alcaraz
authors.initials: EA
authors.lastname: Mateos
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Mariana Fernández
authors.initials: MF
authors.lastname: Caballero
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: José Luis Rodrigo
authors.initials: JL
authors.lastname: Agudo
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Silvia Chacón
authors.initials: SC
authors.lastname: Martínez
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Latorre
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Soria
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Juan Manuel Herrerías
authors.initials: JM
authors.lastname: Gutiérrez
authors.affiliation: Enrique Pérez-Cuadrado Robles, Pilar Esteban Delgado, Paloma Bebia Conesa, Blanca Martínez Andrés, José Luis Rodrigo Agudo, Silvia Chacón Martínez, Enrique Pérez-Cuadrado Martínez, Department of Gastroenterology, Morales Meseguer Hospital, 30008 Murcia, Spain.
authors.forename: Enrique Pérez-Cuadrado
authors.initials: EP
authors.lastname: Martínez
keywords: Double balloon enteroscopy; Gastrointestinal stromal tumor; Malignant small bowel tumors; Obscure gastrointestinal bleeding; Occlusion syndrome