Double-balloon enteroscopy for mesenchymal tumors of small bowel: nine years' experience

Abstract

Aim: To assess the value of double-balloon enteroscopy (DBE) for the diagnosis of gastrointestinal mesenchymal tumors (GIMTs) in the small bowel and clarify their clinical and endoscopic characteristics.

Methods: A retrospective review in a total of 783 patients who underwent a DBE procedure from January 2003 to December 2011 was conducted. Data from patients with pathologically confirmed GIMTs were analyzed at a single tertiary center with nine years' experience. The primary outcomes assessed included characteristics of patients with GIMTs, indications for DBE, overall diagnostic yield of GIMTs, endoscopic morphology, positive biopsy, comparison of diagnosis with capsule endoscopy, and subsequent interventional management.

Results: GIMTs were identified and analyzed in 77 patients. The mean age was 47.74 ± 14.14 years (range: 20-77 years), with 63.6% being males. The majority of individuals presented with gastrointestinal bleeding, accounting for 81.8%, followed by abdominal pain, accounting for 10.4%. Small bowel pathologies were found in 71 patients, the detection rate was 92.2%. The diagnostic yield of DBE for GIMTs was 88.3%. DBE was superior to capsule endoscopy in the diagnosis of GIMTs (P = 0.006; McNemar's χ(2) test). Gastrointestinal stromal tumor was the most frequent and leiomyoma was the second frequent GIMT. Single and focal lesions were typical of GIMTs, and masses with smooth or unsmooth surface were the most common in the small bowel. GIMTs were removed from all the patients surgically except one patient treated with endoscopic resection.

Conclusion: DBE is a safe and valuable procedure for patients with suspected GIMTs, and it provides an accurate position for subsequent surgical intervention.

Keywords: Capsule endoscopy; Double-balloon enteroscopy; Mesenchymal tumor; Small bowel tumor.

Figure 1

Unsmooth surface of verified gastrointestinal mesenchymal tumors, showing the appearance of erosion or ulcer. A, B, F: Ulcerative lesions in the surface of the tumors; C, D, E: Ulcerative and depressed pits (A-D: Gastrointestinal mesenchymal tumor; E: Leiomyoma; F: Lipoma).

Figure 2

Morphology of verified tumors with smooth surface, indicating tumors with sessile base in round or oval shape. A-C: Single tumor with round shape and smooth surface (A, B: Gastrointestinal mesenchymal tumor; C: Lipoma; D: A polyp-like tumor with expanded tail, and hemangioma was confirmed by post-surgical pathology).