Korean J Gastroenterol.  2018 Dec;72(6):277-280. 10.4166/kjg.2018.72.6.277.

Small Bowel Tumors and Polyposis: How to Approach and Manage?

• Ko BM

• KMID: 2429943
• DOI: http://doi.org/10.4166/kjg.2018.72.6.277

Abstract

Although small bowel the mainly occupies the most part of the gastrointestinal tract, small intestine tumors are rare, insidious in clinical presentation, and frequently represent a diagnostic and management challenge. Small bowel tumors are generally classified as epithelial, mesenchymal, lymphoproliferative, or metastatic. Familial adenomatous polyposis and Peutz-Jeghers syndrome are the most common inherited intestinal polyposis syndromes. Until the advent of capsule endoscopy (CE) and device-assisted enteroscopy (DAE) coupled with the advances in radiology, physicians had limited diagnostic examination for small bowel examination. CE and new radiologic imaging techniques have made it easier to detect small bowel tumors. DAE allows more diagnosis and deeper reach in small intestine. CT enteroclysis/CT enterography (CTE) provides information about adjacent organs as well as pictures of the intestinal lumen side. Compared to CTE, Magnetic resonance enteroclysis/enterography provides the advantage of soft tissue contrast and multiplane imaging without radiation exposure. Treatment and prognosis are tailored to each histological subtype of tumors.

Keyword

Small bowel; Intestinal polyposis

MeSH Terms

Adenomatous Polyposis Coli
Capsule Endoscopy
Diagnosis
Gastrointestinal Tract
Intestinal Polyposis
Intestine, Small
Peutz-Jeghers Syndrome
Prognosis
Radiation Exposure

Reference

1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017; 67:7–30.

2. Paski SC, Semrad CE. Small bowel tumors. Gastrointest Endosc Clin N Am. 2009; 19:461–479.

3. Ekberg O, Ekholm S. Radiography in primary tumors of the small bowel. Acta Radiol Diagn (Stockh). 1980; 21:79–84.

4. Laurent F, Raynaud M, Biset JM, Boisserie-Lacroix M, Grelet P, Drouillard J. Diagnosis and categorization of small bowel neoplasms: role of computed tomography. Gastrointest Radiol. 1991; 16:115–119.

5. Kamaoui I, De-Luca V, Ficarelli S, Mennesson N, Lombard-Bohas C, Pilleul F. Value of CT enteroclysis in suspected small-bowel carcinoid tumors. AJR Am J Roentgenol. 2010; 194:629–633.

6. Pilleul F, Penigaud M, Milot L, Saurin JC, Chayvialle JA, Valette PJ. Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis. Radiology. 2006; 241:796–801.

7. Cobrin GM, Pittman RH, Lewis BS. Increased diagnostic yield of small bowel tumors with capsule endoscopy. Cancer. 2006; 107:22–27.

8. Schwartz GD, Barkin JS. Small-bowel tumors detected by wireless capsule endoscopy. Dig Dis Sci. 2007; 52:1026–1030.

9. Brown G, Fraser C, Schofield G, et al. Video capsule endoscopy in peutz-jeghers syndrome: a blinded comparison with barium follow-through for detection of small-bowel polyps. Endoscopy. 2006; 38:385–390.

10. Mata A, Llach J, Castells A, et al. A prospective trial comparing wireless capsule endoscopy and barium contrast series for small-bowel surveillance in hereditary GI polyposis syndromes. Gastrointest Endosc. 2005; 61:721–725.

11. Ohmiya N, Nakamura M, Takenaka H, et al. Management of small-bowel polyps in Peutz-Jeghers syndrome by using enteroclysis, double-balloon enteroscopy, and videocapsule endoscopy. Gastrointest Endosc. 2010; 72:1209–1216.

12. Ciresi DL, Scholten DJ. The continuing clinical dilemma of primary tumors of the small intestine. Am Surg. 1995; 61:698–702.

13. Lewis BS, Eisen GM, Friedman S. A pooled analysis to evaluate results of capsule endoscopy trials. Endoscopy. 2005; 37:960–965.

14. Huprich JE, Fletcher JG, Fidler JL, et al. Prospective blinded comparison of wireless capsule endoscopy and multiphase CT enterography in obscure gastrointestinal bleeding. Radiology. 2011; 260:744–751.

15. Ross A, Mehdizadeh S, Tokar J, et al. Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. Dig Dis Sci. 2008; 53:2140–2143.

16. Sellner F. Investigations on the significance of the adenoma- carcinoma sequence in the small bowel. Cancer. 1990; 66:702–715.

17. Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009; 249:63–71.

18. Sainz-Esteban A, Olmos R, González-Sagrado M, et al. Contribution of 111in-pentetreotide SPECT/CT imaging to conventional somatostatin receptor scintigraphy in the detection of neuroendocrine tumours. Nucl Med Commun. 2015; 36:251–259.

19. Matsumoto T, Esaki M, Yanaru-Fujisawa R, et al. Small-intestinal involvement in familial adenomatous polyposis: evaluation by double-balloon endoscopy and intraoperative enteroscopy. Gastrointest Endosc. 2008; 68:911–919.

20. Wallace MH, Phillips RK. Upper gastrointestinal disease in patients with familial adenomatous polyposis. Br J Surg. 1998; 85:742–750.

21. Giardiello FM, Brensinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology. 2000; 119:1447–1453.

22. Giardiello FM, Trimbath JD. Peutz-Jeghers syndrome and management recommendations. Clin Gastroenterol Hepatol. 2006; 4:408–415.

23. Zucca E, Roggero E, Bertoni F, Cavalli F. Primary extranodal non-Hodgkin's lymphomas. Part 1: gastrointestinal, cutaneous and genitourinary lymphomas. Ann Oncol. 1997; 8:727–737.

24. Flieger D, Keller R, May A, Ell C, Fischbach W. Capsule endoscopy in gastrointestinal lymphomas. Endoscopy. 2005; 37:1174–1180.