Brief Article
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World J Gastroenterol. Dec 21, 2013; 19(47): 9043-9048
Published online Dec 21, 2013. doi: 10.3748/wjg.v19.i47.9043
Small bowel tumors detected and missed during capsule endoscopy: Single center experience
Edyta S Zagorowicz, Anna M Pietrzak, Ewa Wronska, Jacek Pachlewski, Piotr Rutkowski, Ewa Kraszewska, Jaroslaw Regula
Edyta S Zagorowicz, Anna M Pietrzak, Ewa Wronska, Jacek Pachlewski, Ewa Kraszewska, Jaroslaw Regula, Department of Gastroenterology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 02-781 Warsaw, Poland
Piotr Rutkowski, Department of Soft Tissue/Bone Sarcoma and Melanoma, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 02-781 Warsaw, Poland
Edyta S Zagorowicz, Anna M Pietrzak, Ewa Wronska, Jacek Pachlewski, Ewa Kraszewska, Jaroslaw Regula, Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, 01-813 Warsaw, Poland
Author contributions: Zagorowicz ES and Pietrzak AM were responsible for the conception and design of the study, data collection and analysis, drafting the manuscript, and its final approval; Wronska E, Pachlewski J and Zagorowicz ES performed the endoscopic procedures analyzed in the study; Rutkowski P was responsible for GIST data collection and analysis; Kraszewska E was responsible for the statistical analysis and interpretation of the results; Regula J contributed to the study design and critically revised the article for important intellectual content; All the authors were involved in writing the manuscript.
Supported by The Polish Foundation for Gastroenterology
Correspondence to: Anna M Pietrzak, MD, Department of Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5 Roentgen Street, 02-781 Warsaw, Poland. anpietrzak@gmail.com
Telephone: +48-22-5462328 Fax: +48-22-5463035
Received: July 17, 2012
Revised: September 12, 2013
Accepted: September 16, 2013
Published online: December 21, 2013
Processing time: 216 Days and 23.2 Hours
Abstract

AIM: To characterize small bowel (SB) tumors detected by capsule endoscopy (CE), and identify missed tumors.

METHODS: The study included 145 consecutive patients in whom 150 CEs were performed. Following CE, the medical records of the study population were reviewed. Results of double- or single-balloon enteroscopy performed after CE and the results of surgery in all patients operated on were retrieved. The patients were contacted through telephone interviews or postal mail. In addition, the national cancer registry and the polish clinical gastrointestinal stromal tumor (GIST) Registry were searched to identify missed neoplasms.

RESULTS: Indications for CE included overt and occult obscure gastrointestinal bleeding (n = 81, 53.7%), anemia (n = 19, 12.7%), malabsorption (n = 18, 12%), abnormal CB follow through (n = 9, 6%), abdominal pain (n = 7, 5%), celiac disease (n = 5, 3%), neuroendocrine tumor (n = 3, 2%), Crohn’s disease (n = 2, < 2%), Peutz-Jeghers syndrome (n = 2, < 2%), other polyposes (n = 2, < 2%), and diarrhea (n = 2, < 2%). The capsule reached the colon in 115 (76.6%) examinations. In 150 investigations, CE identified 15 SB tumors (10%), 14 of which were operated on or treated endoscopically. Malignancies included metastatic melanoma (n = 1), adenocarcinoma (n = 2), and GIST (n = 3). Benign neoplasms included dysplastic Peutz-Jeghers polyps (n = 4). Non-neoplastic masses included venous malformation (n = 1), inflammatory tumors (n = 2), and a mass of unknown histology (n = 1). During the follow-up period, three additional SB tumors were found (2 GISTs and one mesenteric tumor of undefined nature). The National Cancer Registry and Polish Clinical GIST Registry revealed no additional SB neoplasms in the post-examination period (follow-up: range 4.2-102.5 mo, median 39 mo). The sensitivity of CE for tumor detection was 83.3%, and the negative predictive value was 97.6%. The specificity and positive predictive value were both 100%.

CONCLUSION: Neoplasms may be missed by CE, especially in the proximal SB. In overt obscure gastrointestinal bleeding, complementary endoscopic and/or radiologic diagnostic tests are indicated.

Keywords: Capsule endoscopy; Small bowel tumor; Tumor miss rate; Gastrointestinal bleeding; Gastrointestinal stromal tumor

Core tip: The aims of this study were to characterize small bowel (SB) tumors detected by capsule endoscopy (CE) and identify SB tumors missed by CE. The study included 150 consecutive CE investigations. Following CE, the medical records of the study population were reviewed and the patients contacted by telephone or postal mail. National cancer registries were searched to identify missed neoplasms. CE detected 15 SB tumors (10%). During the follow-up period, three additional SB tumors were found. The sensitivity of CE for tumor detection was 83.3% and the negative predictive value 97.6%. The specificity and positive predictive value were both 100%.