Gastrointestinal Stromal Tumor in Jejunum: Diagnosis Using Contrast-Enhanced Ultrasonography and Double-Balloon Enteroscopy

Abstract

KEY WORDS: gastrointestinal stromal tumor; ultrasonography; double-balloon enteroscopy; contrast-enhancing agent.Gastrointestinal stromal tumors (GISTs) in the small intestine are rare and are sometimes incidentally detected by sudden gastrointestinal bleeding. The patients often undergo surgery without an accurate diagnosis, because most of these lesions are inaccessible by conventional endoscopy. Ultrasonography (US) has become an effective diagnostic modality for gastrointestinal diseases. In addition, recent studies have revealed that the microcirculation of the gastrointestinal wall can be assessed by contrastenhanced imaging using the agent SHU 508A (Levovist; Schering, Berlin, Germany) (1, 2). However, there have been few reports of the sonographic features of GISTs. We report a patient with GIST in the jejunum that was diagnosed by US as a screening tool and that was confirmed preoperatively by double-balloon enteroscopy. CASE REPORTA 75-year-old man was admitted to our hospital because of general fatigue. On hematologic testing, carcinoembryonic antigen (CEA) was slightly increased (7.8 ng/ml), but results of other examinations were normal. He was 159 cm in height and 60 kg in weight, with stable vital signs. Routine abdominal US performed using the SSA-390A system (Toshiba, Tokyo), with 3.5-MHz curved and 7.5-MHz linear array transducers, showed a solid mass with an uneven irregular surface and clear boundaries,

Diagnostic and Therapeutic Procedures in Gastroenterology

“…Abdominal complaints in gastric bypass patients PEG placement in gastric bypass anatomy ERCP in Roux-en-Y situations Previous failed colonoscopy The DBE has also been used to demonstrate a variety of small intestinal disorders, including small bowel lesions (aphthae, erosions, ulcers, and strictures) related to Crohn's disease (Oshitani et al 2006), NSAID-related small bowel injury and diaphragms (Hayashi et al 2005;Yen et al 2006;Nosho et al 2005;Kamata et al 2006), gastrointestinal stromal tumors (Iwamoto et al 2005;Kunihiro et al 2006), carcinoid tumors (Yamaguchi et al 2005), ileal lymphoma (Yoshida et al 2004), jejunal diverticulosis (Kamal and Gerson 2006), eosinophilic jejunitis , an inflammatory polyp causing intussusception (Miyata et al 2004), an anticoagulant ileus (Shinozaki et al 2004), Meckel's diverticulum (Gasbarrini et al 2005;Manner et al 2006;Park and Sohn 2006), Gorham's disease (Ji et al 2005), and small intestinal involvement in familial adenomatous polyposis (Matsumoto et al 2008).…”

Current Status of Double Balloon Endoscopy

“…The capability of real‐time observation as well as histopathological assessment with a targeted biopsy was an advantage of DBE in these case studies. Other small bowel disorders diagnosed by using DBE include GI stromal tumors, 42,43 multiple carcinoid tumors, 44 Gorham's disease, 45 jejunal diverticulosis, 46 and eosinophilic jejunitis 47 …”