Small Bowel Tumors

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Epidemiology

Epidemiologic studies on small bowel tumors are limited, in part, due to their low incidence. Benign small bowel tumors are usually asymptomatic, which makes the precise incidence difficult to determine. Older studies including 22,810 and 2648 autopsies found 35 and 22 benign small bowel tumors, respectively, for an incidence of 0.15% to 0.83%.4, 5 Amongst patients with symptomatic benign small bowel tumors, the most common types are leiomyomas, lipomas, adenomas, and angiomas.6 In autopsy

Risk factors

Several medical and genetic conditions are associated with an increased risk for developing small bowel cancer, including celiac disease, Crohn disease, polyposis syndromes, and hereditary nonpolyposis colorectal cancer. Dietary factors have been associated with small bowel tumors, although study results are inconsistent.

Inflammatory diseases of the small bowel are associated with an increased risk of malignancy. Celiac disease is associated with increased risk for developing small bowel

Symptoms and signs

The diagnosis of small bowel tumors is often delayed because most are asymptomatic or have nonspecific symptoms during the early stages of development. Clinical symptoms reflect the tumor location and pathology. The most common clinical symptoms associated with small bowel tumors are related to obstruction and bleeding. Obstruction usually manifests as recurrent crampy abdominal pain. The pain is usually periumbilical or epigastric and occurs following meals. Some may experience associated

Diagnosis

The nonspecific symptoms of small bowel tumors often result in a long delay in diagnosis. A mean delay of up to 3 years from first symptoms to diagnosis of benign tumors and 18 months for malignant tumors has been reported.9, 25 Diagnosis is often made using a combination of laboratory, radiologic, and endoscopic techniques. Recent advances in radiologic and endoscopic imaging technologies now enable clinicians to visualize the entire small bowel (mucosa and wall). Using these new imaging

Small Bowel Series (SBS)

In some centers with experienced GI radiologists, small bowel series continues to be used in the diagnosis of small bowel tumors. However, this imaging modality is falling out of favor as newer technologies are more sensitive at identifying small bowel tumors, allow simultaneous examination of abdominal organs, and are better tolerated.

Computed Tomographic Enterography and Enteroclysis

Computed tomographic (CT) enterography involves the rapid ingestion of diluted barium just before scanning. A major limitation is the inability of patients to

Video capsule endoscopy

The development of wireless VCE has enabled visualization of the entire small intestine in a noninvasive fashion that is well tolerated by patients. Several studies have assessed the diagnostic yield of capsule endoscopy (CE) compared with other small bowel imaging and endoscopic modalities. One meta-analysis found CE superior to push enteroscopy (63 versus 28%) and SBS (42 versus 6%) in detecting small bowel lesions in the setting of obscure GI bleeding.39 In a review of 416 patients who

Enteroscopy

Push enteroscopy usually reaches the upper jejunum, to an average depth of 80 cm, and is useful for identification and sampling of tumors in the proximal jejunum.52

Double-balloon enteroscopy (DBE), also known as push-and-pull enteroscopy, is a new technique that allows visualization of the entire small bowel and therapeutics.53 This is accomplished using a 2-m enteroscope inserted through an overtube, each with an inflatable balloon attached to its end. Sequential inflation and deflation of the

Small bowel tumor morphology, diagnosis, and management

Small bowel tumors are broadly classified as epithelial, mesenchymal, lymphoproliferative, or metastatic (Table 1). The more common tumors are described in the following sections.

Summary

Although rare, small bowel tumors may cause significant morbidity and mortality if left undetected. New endoscopic modalities allow full examination of the small bowel with improved diagnosis. However, isolated mass lesions may be missed by CE or incomplete balloon-assisted enteroscopy. Therefore the use of radiologic imaging and intraoperative enteroscopy for diagnosis should not be forgotten. Endoscopic resection of small bowel polyps and certain vascular tumors is possible but requires

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