Diagnosis of small bowel tumors by capsule endoscopy in patients with obscure gastrointestinal bleeding

Background: Diagnosis of small bowel tumors is frequently delayed due to the difficulty to visualize the small intestine with current standard imaging methods. Wireless Given® capsule endoscopy (CE) provides a new possibility to improved identification of pathologic changes in the small bowel. Aim: To determine the diagnostic value of CE in patients with obscure gastrointestinal (GI) bleeding caused by small bowel tumors.

Methods: 81 consecutive patients with obscure GI bleeding and negative gastroscopy and colonoscopy were included between October 2001 and November 2003. Standard CE was performed without bowel preparation and after overnight fasting.

Results: Two patients had overt and 4 had occult GI bleeding. The duration of anemia ranged from 4 to 72 months. Small bowel tumors were diagnosed in 6 (3 men and 3 women, age 49–82) of 81 patients (7.4%). Enterography and push enteroscopy identified only one of these six tumors. Two patients had a solitary tumor in the ileum while the multiple tumors were located in the jejunum alone (2 patients) or in both the jejunum and ileum (2 patients). The tumor diagnosis was confirmed at surgery (4 cases) or after biopsy (1 case). Histology revealed 2 carcinoids, 1 hemangioma, 1 hamartoma, 1 GI stromal tumor and one patient is still waiting for surgery and definitive tumor diagnosis.

Conclusions: Small bowel tumors are important to consider in the differential diagnosis in patients with obscure GI bleeding. This study suggests that CE is a sensitive method to diagnose small bowel tumors when compared to conventional techniques.