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

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 smallbowel 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.