Endoscopic characteristics of small intestinal malignant tumors observed by balloon-assisted enteroscopy

doi:10.4253/wjge.v11.i5.373

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World Journal of Gastrointestinal Endoscopy

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World J Gastrointest Endosc. May 16, 2019; 11(5): 373-382
Published online May 16, 2019. doi: 10.4253/wjge.v11.i5.373

Endoscopic characteristics of small intestinal malignant tumors observed by balloon-assisted enteroscopy

Takanori Kanai, Haruhiko Ogata, Masayuki Shimoda, Makoto Naganuma, Seiichiro Fukuhara, Kayoko Fukuhara, Shinta Mizuno, Ryoichi Miyanaga, Kenji JL Limpias Kamiya, Yukie Hayashi, Kaoru Takabayashi, Naoki Hosoe, Tomofumi Horie

Tomofumi Horie, Yukie Hayashi, Kenji JL Limpias Kamiya, Ryoichi Miyanaga, Shinta Mizuno, Makoto Naganuma, Takanori Kanai, Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan

Naoki Hosoe, Kaoru Takabayashi, Kayoko Fukuhara, Seiichiro Fukuhara, Haruhiko Ogata, Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo 160-8582, Japan

Masayuki Shimoda, Department of Pathology, School of Medicine, Keio University, Tokyo 160-8582, Japan

Author contributions: All authors helped to perform the research; Horie T manuscript writing, performing procedures and data analysis; Hosoe N manuscript writing, drafting conception and design, performing procedures, and data analysis; Takabayashi K, Hayashi Y, Limpias Kamiya KJ, Miyanaga R, Mizuno S, Fukuhara K, and Naganuma M, contribution to performing the enteroscopy, drafting conception and design; Fukuhara S, contribution to writing the manuscript; Shimoda M, contribution to pathological data analysis; Ogata H and Kanai T contribution to writing the manuscript, drafting conception and design.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Keio University Hospital (approval number, 20160431).

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Data sharing statement: No additional data are available.

Corresponding author: Naoki Hosoe, MD, PhD, Associate Professor, Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. nhosoe@z5.keio.jp

Telephone: +81-3-33531211 Fax: +81-3-33572778

Received: March 23, 2019
Peer-review started: March 25, 2019
First decision: April 11, 2019
Revised: May 11, 2019
Accepted: May 13, 2019
Article in press: May 14, 2019
Published online: May 16, 2019
Processing time: 55 Days and 0.7 Hours

Abstract

BACKGROUND

Capsule endoscopy and balloon-assisted enteroscopy (BAE) enable visualization of rare small bowel conditions such as small intestinal malignant tumors. However, details of the endoscopic characteristics of small intestinal malignant tumors are still unknown.

AIM

To elucidate the endoscopic characteristics of small intestinal malignant tumors.

METHODS

From March 2005 to February 2017, 1328 BAE procedures were performed at Keio University Hospital. Of these procedures, malignant tumors were classified into three groups, Group 1: epithelial tumors including primary small intestinal cancer, metastatic small intestinal cancer, and direct small intestinal invasion by an adjacent organ cancer; Group 2: small intestinal malignant lymphoma; and Group 3, small intestinal gastrointestinal stromal tumors. We systematically collected clinical and endoscopic data from patients’ medical records to determine the endoscopic characteristics for each group.

RESULTS

The number of patients in each group was 16 (Group 1), 22 (Group 2), and 6 (Group 3), and the percentage of solitary tumors was 100%, 45.5%, and 100%, respectively (P < 0.001). Patients’ clinical background parameters including age, symptoms, and laboratory data were not significantly different between the groups. Seventy-five percent of epithelial tumors (Group 1) were located in the upper small intestine (duodenum and ileum), and approximately 70% of gastrointestinal stromal tumors (Group 3) were located in the jejunum. Solitary protruding or mass-type tumors were not seen in malignant lymphoma (Group 2) (P < 0.001). Stenosis was seen more often in Group 1, (68.8%, 27.3%, and 0%; Group 1, 2, and 3, respectively; P = 0.004). Enlarged white villi inside and/or surrounding the tumor were seen in 12.5%, 54.5%, and 0% in Group 1, 2, and 3, respectively (P = 0.001).

CONCLUSION

The differential diagnosis of small intestinal malignant tumors could be tentatively made based on BAE findings.

Keywords: Small intestine; Malignant; Tumor; Double balloon enteroscopy; Balloon enteroscopy; Video capsule endoscopy; Endoscopy

Core Tip: The aim of this study was to elucidate the endoscopic characteristics of small intestinal malignant tumors. Balloon-assisted enteroscopy procedures at our institution were enrolled in the analysis. Malignant tumors were classified into three groups, Group 1: epithelial tumors; Group 2: small intestinal malignant lymphoma; and Group 3, small intestinal gastrointestinal stromal tumors. We collected data from patients’ medical records to determine the endoscopic characteristics for each group. Group 1 and Group 2 were observed as solitary tumors. Enlarged white villi inside and/or surrounding the tumor were seen in 12.5%, 54.5%, and 0% in Group 1, 2, and 3, respectively (P <0.001).