Digestive Endoscopy Unit, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy.
Surg Endosc. 2012 Feb;26(2):438-41. doi: 10.1007/s00464-011-1896-6. Epub 2011 Sep 10.
The past decade has seen significant advances in the evaluation of the small bowel, long considered as the "black box" in gastroenterology. The development of several endoscopic techniques, including capsule endoscopy (CE) and double (DBE)- and single (SBE)-balloon enteroscopy, has improved the evaluation of this part of the gut and led to reach a more precise preoperative diagnosis of small-bowel tumors. These rare tumors were previously diagnosed only after laparotomy, although laparoscopic advanced surgery can be used for minimally invasive therapeutic approach in these patients. This study was designed to evaluate the diagnostic and therapeutic impact of endoscopic procedures on small-bowel tumors.
During October 2010, 148 SBE procedures were performed; in 14 patients (7 males and 7 females, mean age 58.8 years; range 37-82 years) who suffered from obscure gastrointestinal bleeding, with previous negative upper and lower GI endoscopy, a diagnosis of small-bowel tumor was suspected according to CT scan (7 cases) and/or CE (11 patients). Then, an enteroscopy was performed.
Multiple biopsies were taken in 9 cases; endoscopic tattoos were performed in 11 cases. After endoscopic procedures, histological examination showed melanoma in one case, adenocarcinoma in seven, and adenoma in one case. In 11 of 14 patients, a laparoscopic partial resection of small bowel involved was possible due to endoscopic tattoos. In one patient, the involvement of colic segment precluded a laparoscopic resection. In two patients, the laparoscopic resection was not possible for technical problems. Histological findings on resected specimens were indicative for melanoma in one case, gastrointestinal stromal tumor (GIST) in four cases, gastrointestinal autonomic nerve tumor (GANT) in one case, adenoma in one, and adenocarcinoma in seven cases.
New development of different endoscopic approaches to the small bowel has led to reach an earlier diagnosis of small-bowel tumors and a preoperative diagnosis with consequent minimally invasive surgical approach.
过去十年，小肠的评估取得了重大进展，小肠长期以来被认为是胃肠病学中的“黑匣子”。胶囊内镜（CE）和双球囊（DBE）-和单球囊（SBE）-小肠镜等几种内镜技术的发展改善了对肠道这一部分的评估，并使小肠肿瘤的术前诊断更加精确。这些罕见的肿瘤以前只能在剖腹手术后诊断出来，尽管腹腔镜先进的手术可以用于这些患者的微创治疗方法。本研究旨在评估内镜检查对小肠肿瘤的诊断和治疗影响。
2010 年 10 月期间，进行了 148 例 SBE 检查；在 14 例（7 名男性和 7 名女性，平均年龄 58.8 岁；范围 37-82 岁）因隐匿性胃肠道出血而接受治疗的患者中，根据 CT 扫描（7 例）和/或 CE（11 例），怀疑患有小肠肿瘤。然后进行了小肠镜检查。
9 例患者进行了多次活检；11 例患者进行了内镜纹身。内镜检查后，组织学检查显示 1 例黑色素瘤，7 例腺癌，1 例腺瘤。在 14 例患者中有 11 例，由于内镜纹身，可以进行腹腔镜部分小肠切除术。在 1 例患者中，结肠节段的受累排除了腹腔镜切除术。在 2 例患者中，由于技术问题，腹腔镜切除术不可行。切除标本的组织学检查结果显示 1 例黑色素瘤，4 例胃肠道间质瘤（GIST），1 例胃肠道自主神经肿瘤（GANT），1 例腺瘤，7 例腺癌。
不同的小肠内镜方法的新发展使得能够更早地诊断小肠肿瘤，并进行术前诊断，从而采用微创的手术方法。
