Impact of enteroscopy on diagnosis and management of small bowel tumors

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Abstract

Small bowel tumors (SBTs) have been increasingly diagnosed in recent decades. The pathogenesis of this increment is largely unknown, but advances in radiological and endoscopic methods facilitate the improvement of the diagnosis. Capsule endoscopy (CE) and device-assisted enteroscopy (DAE) allow the clinician to assess the entire small bowel in the search for suspicious lesions, or a cause of symptoms. In this review, we discuss the role of enteroscopy, techniques and strategies in the diagnosis and management of SBTs, and a brief description of the most common tumors.

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ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

Lauren Gerson, Jeff L Fidler, David R Cave … (2015)

Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.

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Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST).

Ronald P Dematteo, Jason Gold, Lisa Saran … (2008)

Gastrointestinal stromal tumor (GIST) is the most frequent sarcoma of the intestinal tract and often shows constitutive activation of either the KIT or PDGFRA receptor tyrosine kinases because of gain-of-function mutation. Although the efficacy of tyrosine kinase inhibitors in metastatic GIST depends on tumor mutation status, there have been conflicting reports on the prognostic importance of KIT mutation in primary GIST. A total of 127 patients were studied who presented to our institution from 1983 to 2002 with localized primary GIST and underwent complete gross surgical resection of disease. The majority of tumors originated in the stomach (58%) or small intestine (28%). By using polymerase chain reaction (PCR) and direct sequencing, a KIT mutation was found in 71% of patients and a PDGFRA mutation in 6%. After a median follow-up of 4.7 years, recurrence-free survival was 83%, 75%, and 63% at 1, 2, and 5 years, respectively. On multivariate analysis recurrence was predicted by > or =5 mitoses/50 high-power fields, tumor size > or =10 cm, and tumor location (with patients having small bowel GIST doing the worst). In particular, a high mitotic rate conferred a hazard rate of 14.6 (95% confidence interval, 6.5-32.4). Specific KIT mutations had prognostic importance by univariate but not multivariate analysis. Patients with KIT exon 11 point mutations and insertions had a favorable prognosis. Those with KIT exon 9 mutations or KIT exon 11 deletions involving amino acid W557 and/or K558 had a higher rate of recurrence, whereas patients without a tyrosine kinase mutation had intermediate outcome. In the absence of therapy with tyrosine kinase inhibitors, recurrence in completely resected primary GIST is independently predicted by mitotic rate, tumor size, and tumor location.

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ENETS Consensus Guidelines Update for Neuroendocrine Neoplasms of the Jejunum and Ileum

B Niederle, U-F Pape, F. Costa … (2016)

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Adriana Vaz Safatle-Ribeiro

Journal

Journal ID (nlm-ta): Chin J Cancer Res

Journal ID (iso-abbrev): Chin. J. Cancer Res

Journal ID (publisher-id): CJCR

Title: Chinese Journal of Cancer Research

Publisher: AME Publishing Company

ISSN (Print): 1000-9604

ISSN (Electronic): 1993-0631

Publication date (Print): June 2020

Volume: 32

Issue: 3

Pages: 319-333

Affiliations

[1] Endoscopy Unit of the Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), São Paulo 01327-002, Brazil

Author notes

Adriana Vaz Safatle-Ribeiro, MD, PhD, FACG. Endoscopy Unit of the Department of Gastroenterology, São Paulo Cancer Institute, University of São Paulo Medical School (ICESP-HCFMUSP), Rua Treze de Maio, 1954, cj 54, São Paulo 01327-002, Brazil. Email: adrisafatleribeiro@ 123456terra.com.br

Article

Publisher ID: cjcr-32-3-319

DOI: 10.21147/j.issn.1000-9604.2020.03.04

PMC ID: 7369182

PubMed ID: 32694897

SO-VID: 185c2405-db0f-4bf4-8820-06afcc7b1db1

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This work is licensed under a Creative Commons Attribution-Non Commercial-Share Alike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

Impact of enteroscopy on diagnosis and management of small bowel tumors

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Most cited references 109

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST).

ENETS Consensus Guidelines Update for Neuroendocrine Neoplasms of the Jejunum and Ileum

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