Role of double-balloon enteroscopy in malignant small bowel tumors

Robles, Enrique Pérez‐Cuadrado; Delgado, Pilar; Conesa, Paloma Bebia; Andrés, Bruno; Guggiana, Milivoj Franulic; Mateos, Eduardo Alcaraz; Caballero, Mariana Fernández; Agudo, José Luís Rodrigo; Martínez, Silvia Chacón; Latorre, R.; Soria, Federico; Gutiérrez, Juan Manuel Herrerías; Pérez-Cuadrado-Martínez, Enrique

doi:10.4253/wjge.v7.i6.652

Cited by 29 publications

(41 citation statements)

References 34 publications

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“…The first-line treatment for small intestinal GISTs with excessive bleeding remains debatable (10,11). The endoscopic treatment by DBE is very limited in massive GIST bleeding, but it may be possible, delaying or averting emergency surgery (9). In the present case, DBE was unable to avert emergency surgery, but located the level of the bleeding and guided resection.…”

Section: Discussionmentioning

confidence: 72%

“…The most common clinical indications of GISTs include obscure bleeding, abdominal pain, anemia, chronic diarrhea and inflammatory bowel disease (8). Robles et al (9) reported that the histological detection rate of GISTs by DBE biopsy was 71.4%. The first-line treatment for small intestinal GISTs with excessive bleeding remains debatable (10,11).…”

Section: Discussionmentioning

confidence: 99%

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Emergency surgery for hemorrhagic shock caused by a gastrointestinal stromal tumor of the ileum: A case report

Shimazaki

Tabuchi

Nishida

et al. 2016

Molecular and Clinical Oncology

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Abstract. In this report, a case of hemorrhagic shock caused by a gastrointestinal stromal tumor (GIST) of the ileum, which was successfully treated by emergency surgery, is presented. A 67-year-old male patient presented to the Ibaraki Medical Center, Tokyo Medical University (Ami, Japan) in July 18, 2014, with dizziness and blood in the stool. Upper endoscopy and colonoscopy failed to reveal the source of the hemorrhage, although abdominal contrast-enhanced computed tomography revealed extravasation of the contrast medium into the small intestine. The patient developed hemorrhagic shock; thus, double-balloon enteroscopy (DBE) was performed, which revealed a Meckel's diverticulum and a submucosal tumor with excessive bleeding at 60 and 100 cm proximal to the ileocecal valve, respectively. Subsequent emergency partial resection of the ileum, including the tumor and the Meckel's diverticulum, was performed in July 20, 2014. Histological examination of the excised tumor revealed proliferation of spindle-shaped cells, and immunohistochemical staining of the tumor was positive for CD34, KIT and α-smooth muscle actin, but negative for S-100 protein. These immunohistological results supported the diagnosis of GIST of the ileum. The patient had an uneventful recovery and has been monitored at our outpatient clinic for 14 months after surgery. This case demonstrated the efficacy of DBE for the diagnosis of small intestinal bleeding, and immediate emergency surgery should be considered for cases of small intestinal GISTs with excessive bleeding. IntroductionGastrointestinal stromal tumors (GISTs) are rare tumors that may arise from any site of the GI tract and are generally associated with abdominal pain, GI bleeding, or a palpable mass. However, a small intestinal GIST rarely causes hemorrhagic shock. We herein report a case of hemorrhagic shock with excessive bleeding caused by an ileal GIST that was managed by emergency surgery. The patient provided written informed consent for the publication of this case report. Case reportA 67-year-old male patient presented to the Department of Gastroenterology of the Ibaraki Medical Center, Tokyo Medical University (Ami, Japan) in July 18, 2014, with dizziness and blood in the stool. The patient's medical history included treatment for hypertension by a local physician. The findings of the subsequent physical examination were unremarkable, except for low blood pressure (97̸60 mmHg) and mild pallor of the palpebral conjunctiva. Laboratory data revealed mild anemia (hemoglobin, 10.2 g̸dl) and increased blood urea nitrogen (34.1 mg̸dl). Upper endoscopy revealed no hemorrhagic lesion of the duodenum, stomach, or esophagus. Colonoscopy revealed fresh blood with clotting discharged from the proximal side of the ileocecal valve; no hemorrhagic lesion of the colon or rectum was identified. Abdominal contrast-enhanced computed tomography (CT) revealed extravasation of the contrast medium into the small intestine (Fig. 1). The intestinal bleeding continued, and the patient eventually devel...

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Emergency surgery for hemorrhagic shock caused by a gastrointestinal stromal tumor of the ileum: A case report

Shimazaki

Tabuchi

Nishida

et al. 2016

Molecular and Clinical Oncology

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“…According to the report, small bowel tumors included GIST (28.6% to 32.1%), adenocarcinomas (20.5% to 25%), neuroendocrine tumor (14.3% to 15.2%), malignant lymphomas (10.7% to 14.3%), adipose tumors (8.9%), metastatic tumors (10.7%), and Kaposi sarcoma (3.6%) [11,12] . Furthermore, the types of malignant small bowel tumor included adenocarcinoma (47%), carcinoid (28%), leiomyosarcoma (13%), and lymphoma (12%) [13] .…”

Section: Discussionmentioning

confidence: 99%

Investigation of Undetected Small Bowel Tumors on Capsule Endoscopy

Maeda

Hiraishi

2015

Journal of Gastroenterology and Hepatology Research

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CONCLUSION:On CE, small bowel tumors showed atypical features, including a smooth submucosal bulge and the presence of ulcerated lesions and of blood, bowel residue, or feces, probably due to regional transit abnormalities related to the tumor. In such cases, it may be necessary to perform computed tomography, positron emission tomography/computed tomography, other examinations, or repeat CE after performing colonic irrigation to remove bowel residue. RESULTS:Of the 21 patients, CE accurately diagnosed tumors in 12 patients (57.1%). However, tumors were not detected in 9 patients because of a poor endoscopic view due to visual obstruction caused by blood, bowel residue, or feces (n=5; 23.8%), the presence of ulcerated lesions (n=3; 14.3%), or angioectasia (n=1; 4.8%). The sources of bleeding were considered to be ulcerated lesions or angioectasia. Of the 9 patients, 7 patients had tumors in the duodenum or the proximal jejunum. ORIGINAL ARTICLE Investigation of Undetected Small Bowel Tumors on Capsule EndoscopyMitsunori Maeda, Hideyuki Hiraishi Journal of Gastroenterology and Hepatology Researchlesions is a major issue, with the failure to detect neoplastic lesions having a major impact on prognosis. According to the literature, the rate of undetected neoplastic lesions in small-bowel CE is high (44.1% to 83.3%) [1][2][3][4] . Therefore, the aim of this study was to review CE findings in patients with small bowel tumors and analyze cases in which CE failed to detect tumors.

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“…The most common SBTs are gastrointestinal stromal tumor (GIST), adenocarcinoma, NET, and lymphoma [79]. Overall, SBTs are more frequent in the jejunum, followed by the duodenum and ileum, and most present with SBB [80][81][82][83].…”

Section: Small Bowel Tumorsmentioning

confidence: 99%

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

Pérez-Cuadrado-Robles

Pinho

González

et al. 2020

GE Port J Gastroenterol

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The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.

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Role of double-balloon enteroscopy in malignant small bowel tumors

Abstract: DBE may be critical in the management of MSBT providing additional information that may be decisive in the clinical course of these patients.

Cited by 29 publications

References 34 publications

Emergency surgery for hemorrhagic shock caused by a gastrointestinal stromal tumor of the ileum: A case report

Emergency surgery for hemorrhagic shock caused by a gastrointestinal stromal tumor of the ileum: A case report

Investigation of Undetected Small Bowel Tumors on Capsule Endoscopy

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

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