Skip to main content

Advertisement

Log in

Double-Balloon Enteroscopy and Small Bowel Tumors: A South-European Single-Center Experience

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Small bowel tumors are rare, accounting for 1–2% of all gastrointestinal neoplasms. We sought to determine the diagnostic and therapeutic impact of double-balloon enteroscopy (DBE) in patients with small bowel tumors. Between January 2005 and March 2008, 78 patients underwent 96 DBE. All nine patients (seven males; mean age 68 ± 11.3 years) with small bowel tumors were retrospectively reviewed. Clinical presentation was: mid-gastrointestinal bleeding or iron-deficient anemia (55.6%); abdominal pain (22.2%); nausea/vomiting and abdominal distension (22.2%). Five patients had abnormal findings in previous capsule endoscopy and four in previous radiologic examinations. Route of insertion was exclusively oral and abnormal lesions were detected in all patients (jejunum 8; ileum 1). Biopsies were taken in seven patients and provided definitive histological diagnosis in all except one. There were no complications of DBE. Surgical resection took place in eight patients. Final histologic diagnosis were: primary carcinoma (33.3%), gastrointestinal stromal tumor (GIST) (33.3%), malignant lymphoma (22.2%), and carcinoid tumor (11.1%). Mean follow-up time was 15.4 ± 12.7 months (range 2–34 months). Six patients were submitted to chemotherapy. Two patients died. Small bowel tumors are common in patients submitted to DBE. Given its safety and diagnostic capabilities, DBE should be considered the gold-standard method in the study of these neoplasms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gay C, Delvaux M. Small-bowel endoscopy. Endoscopy. 2008;40:140–146. doi:10.1055/s-2007-995419.

    Article  PubMed  CAS  Google Scholar 

  2. Rustgi AK. Small intestinal neoplasms. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Elsevier; 2006:2703–2712.

  3. Hatzaras I, Palesty JA, Abir F, et al. Small-bowel tumors: epidemiologic and clinical characteristics of 1,260 cases from the connecticut tumor registry. Arch Surg. 2007;142:229–235. doi:10.1001/archsurg.142.3.229.

    Article  PubMed  Google Scholar 

  4. Moglia A, Menciassi A, Dario P, Cuschieri A. Clinical update: endoscopy for small-bowel tumors. Lancet. 2007;370:114–116. doi:10.1016/S0140-6736(07)61066-6.

    Article  PubMed  Google Scholar 

  5. Kala Z, Válek V, Kysela P, Svoboda T. A shift in the diagnostics of the small intestine tumors. Eur J Radiol. 2007;62:160–165. doi:10.1016/j.ejrad.2007.01.023.

    Article  PubMed  Google Scholar 

  6. Jakobs R, Hartmann D, Benz C, et al. Diagnosis of obscure gastrointestinal bleeding by intra-operative enteroscopy in 81 consecutive patients. World J Gastroenterol. 2006;12:313–316.

    PubMed  Google Scholar 

  7. Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature. 2000;405:417. doi:10.1038/35013140.

    Article  PubMed  CAS  Google Scholar 

  8. Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with non-surgical steerable double-balloon method. Gastrointest Endosc. 2001;53:216–220. doi:10.1067/mge.2001.112181.

    Article  PubMed  CAS  Google Scholar 

  9. Hartmann D, Schmidt H, Bolz G, et al. A prospective two-center study comparing wireless capsule endoscopy with intraoperative enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc. 2005;61:826–832. doi:10.1016/S0016-5107(05)00372-X.

    Article  PubMed  Google Scholar 

  10. Pennazio M. Capsule endoscopy: where are we after 6 years of clinical use? Dig Liver Dis. 2006;38:867–878. doi:10.1016/j.dld.2006.09.007.

    Article  PubMed  CAS  Google Scholar 

  11. Yamagami H, Oshitani N, Suekane T, et al. Clinical impact of double balloon endoscopy on the diagnosis of malignant small bowel tumors: a single center experience. Gastrointest Endosc. 2008;67:AB268. doi:10.1016/j.gie.2008.03.738.

    Article  Google Scholar 

  12. Ross AS, Semrad C, Waxman I, Dye C. Enteral stent placement by double balloon enteroscopy for palliation of malignant small bowel obstruction. Gastrointest Endosc. 2006;64:835–837. doi:10.1016/j.gie.2006.03.001.

    Article  PubMed  Google Scholar 

  13. Gay G, Delvaux M, Fassler I. Indications of CE. In: Gay G, ed. Capsule Endoscopy of the Small Bowel. ALN editions; 2006:24–63.

  14. de Franchis R, Ronnotti E, Abbiati C, Beccari G, Signorelli C. Small bowel malignancy. Gastrointest Endosc Clin North Am. 2004;14:139–148. doi:10.1016/j.giec.2003.10.006.

    Article  Google Scholar 

  15. Cobrin GM, Pittman RH, Lewis BS. Increased diagnostic yield of small bowel tumors with capsule endoscopy. Cancer. 2006;107:22–27. doi:10.1002/cncr.21975.

    Article  PubMed  Google Scholar 

  16. Bailey AA, Debinski HS, Appleyard MN, et al. Diagnosis and outcome of small bowel tumors found by capsule endoscopy: a three-center Australian experience. Am J Gastroenterol. 2006;101:2237–2243. doi:10.1111/j.1572-0241.2006.00749.x.

    Article  PubMed  Google Scholar 

  17. Estévez E, González-Conde B, Vázquez-Iglesias JL, Alonso PA, Vázquez-Millán Mde L, Pardeiro R. Incidence of tumoral pathology according to study using capsule endoscopy for patients with obscure gastrointestinal bleeding. Surg Endosc. 2007;21:1776–1780. doi:10.1007/s00464-007-9242-8.

    Article  PubMed  Google Scholar 

  18. Urbain D, De Looze D, Demedts I, et al. Video capsule endoscopy in small-bowel malignancy: a multicenter Belgian study. Endoscopy. 2006;38:408–411. doi:10.1055/s-2005-921203.

    Article  PubMed  CAS  Google Scholar 

  19. Rondonotti E, Villa F, Mulder CJ, Jacobs MA, de Franchis R. Small bowel capsule endoscopy in 2007: Indications, risks and limitations. World J Gastroenterol. 2007;13:6140–6149. doi:10.3748/wjg.13.6140.

    Article  PubMed  Google Scholar 

  20. Lewis S. Obscure GI bleeding in the world of capsule endoscopy, push and double balloon enteroscopies. Gastrointest Endosc. 2007;66:S66–S68. doi:10.1016/j.gie.2007.01.015.

    Article  PubMed  Google Scholar 

  21. Mensink PB, Haringsma J, Kucharzik T, et al. Complications of double balloon enteroscopy: a multicenter survey. Endoscopy. 2007;39:613–615. doi:10.1055/s-2007-966444.

    Article  PubMed  CAS  Google Scholar 

  22. Kita H, Yamamoto H, Yano T, et al. Double balloon endoscopy in two hundred fifty cases for the diagnosis and treatment of small intestinal disorders. Inflammopharmacol. 2007;15:74–77. doi:10.1007/s10787-006-1568-7.

    Article  CAS  Google Scholar 

  23. Cazzato IA, Cammarota G, Nista EC, et al. Diagnostic and therapeutic impact of double-balloon enteroscopy (DBE) in a series of 100 patients with suspected small bowel diseases. Dig Liver Dis. 2007;39:483–487. doi:10.1016/j.dld.2007.01.019.

    Article  PubMed  CAS  Google Scholar 

  24. Delgado PE, Cortés ET, Pérez-Cuadrado E. Tumores. In: Enrique Pérez-Cuadrado Martínez, ed. Enteroscopia de Doble Balón. Grupo Editorial Entheos; 2007:145–166.

  25. Lepage C, Bouvier AM, Manfredi S, Dancourt V, Faivre J. Incidence and management of primary malignant small bowel cancers: a well-defined French population study. Am J Gastroenterol. 2006;101:2826–2832. doi:10.1111/j.1572-0241.2006.00854.x.

    Article  PubMed  Google Scholar 

  26. Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol. 2000;7:705–712. doi:10.1007/s10434-000-0705-6.

    Article  PubMed  CAS  Google Scholar 

  27. Hwang JH, Rulyak SD, Kimmey MB. American Gastroenterological Association Institute. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology. 2006;130:2217–2228. doi:10.1053/j.gastro.2006.04.033.

    Article  PubMed  Google Scholar 

  28. Gay G, Delvaux M, Fassler I. Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy. Endoscopy. 2006;38:49–58. doi:10.1055/s-2005-921176.

    Article  PubMed  CAS  Google Scholar 

  29. Chong AK, Chin B, Meredith CG. Clinically significant small-bowel pathology identified by double-balloon enteroscopy but missed by capsule endoscopy. Gastrointest Endosc. 2006;64:445–449. doi:10.1016/j.gie.2006.04.007.

    Article  PubMed  Google Scholar 

  30. Mehdizadeh S, Ross A, Gerson L, et al. What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. Gastrointest Endosc. 2006;64:740–750. doi:10.1016/j.gie.2006.05.022.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nuno Almeida.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Almeida, N., Figueiredo, P., Lopes, S. et al. Double-Balloon Enteroscopy and Small Bowel Tumors: A South-European Single-Center Experience. Dig Dis Sci 54, 1520–1524 (2009). https://doi.org/10.1007/s10620-008-0512-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-008-0512-7

Keywords

Navigation