Small-bowel masses found and missed on capsule endoscopy for obscure bleeding

Scand J Gastroenterol. 2007 Sep;42(9):1127-32. doi: 10.1080/00365520701266898.

Abstract

Objective: Data on the nature of small-bowel tumors found or missed by capsule endoscopy (CE) are limited. The aim of this study was to review the CE findings in patients with small-bowel tumors presenting as obscure gastrointestinal (GI) bleeding.

Material and methods: We retrospectively reviewed the medical records of the first 300 patients who underwent CE for obscure bleeding (non-diagnostic EGD and colonoscopy) at our institution.

Results: Ten (3%) confirmed small-bowel masses were found in 9 patients. CE findings included distinct mass (n=4), focal irregular (ulcerated or nodular) mucosa (n=2), focal blood without clear lesion (n=1), proximal angiodysplasia with obscuring distal melena (n=1), incomplete distal examination with normal proximal images (n=1), and normal findings (n=1). Most (80%) of the lesions were potentially malignant: adenocarcinoma (n=4), neuroendocrine carcinoma (n=1), leiomyosarcoma (n=1), and GI stroma cell tumors (GISTs) (n=2). Benign lesions included inflammatory fibroid polyp (n=1) and lipoma (n=1). Three duodenal masses were missed on a previous EGD; one was missed by CE as well. CE findings led directly to tumor diagnosis in 7 of the 10 cases. Capsule retention occurred in 2 of the 10 cases, with one patient requiring urgent surgery for acute obstruction.

Conclusions: Small-bowel tumors are a rare but serious source of obscure GI bleeding. Our large single-center experience shows that most lesions are of malignant potential. Tumors can have an atypical appearance including focal ulceration, nodularity, or active bleeding without a clear lesion. Mass lesions in the duodenum are particularly elusive and can be missed by both EGD and CE.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Capsule Endoscopy*
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Humans
  • Intestinal Neoplasms / complications
  • Intestinal Neoplasms / diagnosis*
  • Intestinal Neoplasms / surgery
  • Intestine, Small
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome