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.
World J Gastroenterol. 2013 Dec 21;19(47):9043-8. doi: 10.3748/wjg.v19.i47.9043.
To characterize small bowel (SB) tumors detected by capsule endoscopy (CE), and identify missed tumors.
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.
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%.
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.
描述胶囊内镜（CE）检测到的小肠（SB）肿瘤，并确定遗漏的肿瘤。
本研究纳入了 145 例连续患者，对其中 150 例患者进行了 CE 检查。CE 后，回顾研究人群的病历。检索了 CE 后行双球或单球肠内镜检查的结果和所有手术患者的手术结果。通过电话访谈或邮寄方式联系患者。此外，还检索了国家癌症登记处和波兰临床胃肠道间质瘤（GIST）登记处，以确定遗漏的肿瘤。
CE 的适应证包括显性和隐性不明原因胃肠道出血（n=81，53.7%）、贫血（n=19，12.7%）、吸收不良（n=18，12%）、异常 CB 随访（n=9，6%）、腹痛（n=7，5%）、乳糜泻（n=5，3%）、神经内分泌肿瘤（n=3，2%）、克罗恩病（n=2，<2%）、Peutz-Jeghers 综合征（n=2，<2%）、其他息肉（n=2，<2%）和腹泻（n=2，<2%）。115 例（76.6%）检查中胶囊到达结肠。在 150 次检查中，CE 发现 15 例 SB 肿瘤（10%），其中 14 例经手术或内镜治疗。恶性肿瘤包括转移性黑色素瘤（n=1）、腺癌（n=2）和 GIST（n=3）。良性肿瘤包括发育不良的 Peutz-Jeghers 息肉（n=4）。非肿瘤性肿块包括静脉畸形（n=1）、炎性肿瘤（n=2）和性质不明的肿块（n=1）。在随访期间，又发现了 3 例 SB 肿瘤（2 例 GIST 和 1 例肠系膜肿瘤）。国家癌症登记处和波兰临床 GIST 登记处未发现检查后（随访：范围 4.2-102.5 个月，中位数 39 个月）的其他 SB 肿瘤。CE 对肿瘤检测的敏感性为 83.3%，阴性预测值为 97.6%。特异性和阳性预测值均为 100%。
CE 可能遗漏肿瘤，特别是在 SB 近端。在显性不明原因胃肠道出血中，应进行补充内镜和/或影像学诊断检查。
