Enteroscopic and radiologic diagnoses, treatment, and prognoses of small-bowel tumors

Background: Small-bowel tumors (SBTs) represent a diagnostic challenge. Objective: To evaluate the usefulness of contrast-enhanced CT (CECT), fluoroscopic enteroclysis (FE), video-capsule endoscopy (VCE), and double-balloon endoscopy (DBE) and the outcome after treatment. Design: Single-center, retrospective study. Setting: Tertiary-care referral hospital. Patients: Between June 2003 and May 2011, 159 consecutive patients with SBTs (93 malignant and 66 benign) were enrolled. Main Outcome Measurements: Comparison of diagnostic yields among CECT, FE, VCE, and DBE and the prognosis. Results: CECT and FE had significantly lower diagnostic yields of SBTs <= 10 mm, but VCE and DBE had high yields of SBTs regardless of size. CECT had a significantly lower diagnostic yield of epithelial tumors compared with subepithelial tumors. When stratified by the site, the diagnostic yield of VCE for SBTs located only in the distal duodenum/the proximal jejunum (73%) was significantly lower than that for SBTs located in other areas (90%). Comparisons among the 4 methods revealed that VCE and DBE had significantly higher diagnostic yields than CECT, and DBE had significantly higher diagnostic yields than VCE, but a combination of CECT and VCE had a diagnostic yield similar to that of DBE. The histologic diagnostic yield of SBTs by DBE was 92%, and 25% of SBTs were enteroscopically treated. Metastatic tumors had the poorest overall survival, followed by adenocarcinomas and malignant lymphomas. Limitations: Retrospective comparative study. Conclusion: For the detection of SBTs, a combination screening method by using VCE and CECT is recommended. DBE is useful for histologic diagnosis and endoscopic treatment. (Gastrointest Endosc 2012;76:344-54.)