• small bowel
• adenocarcinoma
• double contrast
• jejunum
• ultrasound

• Adenocarcinoma de intestino delgado
• Enteroclisis
• Enteroclysis
• Gastrointestinal stromal tumors
• Neuroendocrine tumors
• Small bowel adenocarcinoma
• Tumores del estroma gastrointestinal
• Tumores neuroendocrinos

• Humans
• Middle Aged
• Male
• Female
• Retrospective Studies
• Chile/epidemiology
• Hospitals, University/statistics & numerical data
• Prognosis
• Aged
• Intestinal Neoplasms/epidemiology
• Intestinal Neoplasms/pathology
• Intestinal Neoplasms/diagnosis
• Intestine, Small/pathology
• Adult
• Gastrointestinal Stromal Tumors/epidemiology
• Gastrointestinal Stromal Tumors/pathology
• Gastrointestinal Stromal Tumors/diagnosis
• Aged, 80 and over
• Survival Rate
• Neuroendocrine Tumors/epidemiology
• Neuroendocrine Tumors/diagnosis
• Neuroendocrine Tumors/pathology
• Adenocarcinoma/epidemiology
• Adenocarcinoma/diagnosis
• Adenocarcinoma/pathology
• Young Adult
• Lymphoma/epidemiology
• Lymphoma/diagnosis
• Lymphoma/pathology

• Angioectasias
• Device-assisted enteroscopy
• Dieulafoy lesions
• Endoscopic therapy
• Push enteroscopy
• Small bowel bleeding
• Small bowel capsule endoscopy

• Humans
• Endoscopy, Gastrointestinal/adverse effects
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Intestine, Small/surgery
• Capsule Endoscopy
• Epinephrine/therapeutic use

• Adenocarcinoma
• Gastrointestinal stromal tumor
• Malignant lymphoma
• Small bowel tumor

• Humans
• Gastrointestinal Stromal Tumors/diagnostic imaging
• Gastrointestinal Stromal Tumors/pathology
• Retrospective Studies
• Intestinal Neoplasms/diagnostic imaging
• Intestinal Neoplasms/epidemiology
• Adenocarcinoma/diagnostic imaging
• Abdominal Pain
• Asymptomatic Diseases

• Humans
• Neuroendocrine Tumors/diagnosis
• Neuroendocrine Tumors/therapy
• Octreotide/therapeutic use
• Somatostatin/therapeutic use
• Prognosis
• Intestinal Neoplasms/diagnosis
• Intestinal Neoplasms/therapy
• Intestinal Neoplasms/complications

• Anemia of unknown origin
• Gastrointestinal stromal tumors
• Small intestine

• Diagnosis
• Double-balloon enteroscopy
• Neoplasms
• Small intestine

• Device-assisted enteroscopy
• Gastrointestinal bleeding
• Iron-deficiency anemia
• Small bowel mass lesions
• Tumors of the small intestine
• Video capsule endoscopy

• Capsule endoscopy
• Diagnosis
• Double-balloon enteroscopy
• Endoscopy
• Gastro-entero-pancreatic neuroendocrine neoplasms
• Staging
• Therapy
• Ultrasound endoscopy

• Endoscopy, Gastrointestinal
• Endosonography
• Humans
• Intestinal Neoplasms/diagnostic imaging
• Intestinal Neoplasms/surgery
• Neuroendocrine Tumors/diagnostic imaging
• Neuroendocrine Tumors/surgery
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/surgery
• Prospective Studies
• Retrospective Studies
• Stomach Neoplasms/pathology

• Capsule endoscopy
• Double balloon enteroscopy
• Enteroscopy
• Small bowel bleeding

• Adenocarcinoma
• Adjuvant therapy
• Chemotherapy
• Small bowel cancer

• glasgow–blatchford score
• clinical rockall score
• aims65 score
• small bowel bleeding
• roc curve

• Adult
• Aged
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Blood Transfusion
• Cardiovascular Diseases/epidemiology
• Comorbidity
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Hypertension/epidemiology
• Middle Aged
• Prognosis
• ROC Curve
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index

•

Adenocarcinoma of jejunum is a very rare malignant tumor worldwide.

We report a rare case of a patient diagnosed with adenocarcinoma of the jejunum.

The patient was a 58-year-old female patient who was tested for vomiting and dyspeptic symptoms at a local hospital and visited the hospital due to suspected small bowel obstruction. CT enteroscopy performed at our clinic revealed “progression of focal wall thickening in small bowel with proximal bowel dilatation”, and it was necessary to differentiate between malignant and infectious lesions. Balloon enteroscopy was planned for endoscopic observation up to the small bowel. The biopsy result was confirmed as adenocarcinoma with moderated differentiated. The patient underwent small bowel resection and anastomosis using standard laparoscopic surgery. Jejunum resection was performed by securing a safety margin of 10 cm or more, and sufficient LN dissection was also performed. The patient was discharged from the hospital without any specific complications, and as a result of pathology examination, it was confirmed as a stage 2 high risk group, and further treatment is in progress.

There are few reports of patients diagnosed with adenocarcinoma of the jejunum through symptoms of obstruction of the small intestine.

We report on a case of laparoscopic surgery for a rare jejunal cancer confirmed histologically before surgery.

• Case report
• Enteroscopy
• Jejunal cancer
• Laparoscopic surgery
• Small bowel cancer

• Capsule endoscopy
• Double-balloon enteroscopy
• Enteroscopy
• Neuroendocrine neoplasms
• Small bowel

• Double-Balloon Enteroscopy
• Endoscopy, Gastrointestinal
• Humans
• Ileum
• Intestinal Diseases
• Intestinal Neoplasms/diagnostic imaging
• Intestine, Small/diagnostic imaging
• Male
• Middle Aged
• Prospective Studies
• Retrospective Studies

Small bowel malignancies often present a diagnostic challenge due to their relative rarity and nonspecific clinical symptoms. However, technical developments in endoscopic instruments, including video capsule endoscopy (VCE) and enteroscopy, have allowed for the visualization of the entire small bowel. This study aimed to investigate the clinicopathological features of small bowel malignant tumors diagnosed by VCE and double-balloon enteroscopy (DBE) in a single tertiary center.

We retrospectively analyzed VCE and DBE findings from Korea University Guro Hospital from January 2010 through September 2018.

A total of 510 VCE and 126 DBE examinations were performed in 438 patients. Small bowel malignancies were diagnosed in 28 patients (15 males; mean age, 61.0 years; range, 42 to 81 years). Among them, 8 had lymphoma, 8 had primary adenocarcinoma, 7 had gastrointestinal stromal tumor (GIST) and 5 had metastatic cancer. Abdominal pain and obstructive symptoms were the most common findings in metastatic cancers (4/5, 80%). On the other hand, obscure gastrointestinal bleeding was the most common symptom of GIST (6/7, 85.7%) and adenocarcinoma (3/8, 37.5%).

Approximately 6% of the patients who underwent either VCE or DBE were diagnosed with small bowel malignancy. These findings demonstrated the different clinical characteristics among small bowel malignancies and merit further study.

• Capsule endoscopy
• Endoscopy
• Neoplasms
• Small intestine

Double-balloon enteroscopy (DBE) is widely used worldwide. However, comparisons between the diagnostic yields in adults and the elderly remain scarce.

The aim of this study is to compare the diagnostic yields and safety of DBE between adults and elderly with obscure gastrointestinal bleeding and incomplete small bowel obstruction.

We retrospectively reviewed patients who underwent DBE with indication of obscure gastrointestinal bleeding or incomplete small bowel obstruction in Ruijin Hospital and classified them into adults (18–64 years old) and elderly (≥65 years old). Clinical characteristics, diagnostic yields, and postoperative complications were collected and further analyzed.

A total of 877 DBE procedures, 729 in adults and 148 in the elderly, were performed. In the patients with OGIB, the adults showed a higher frequency of Meckel's diverticulum compared with the elderly (4.6% vs. 0.9%, P = 0.032). Angioectasia was higher in frequency in the elderly than in the adults (25.9% vs. 17.9%, P = 0.048). In patients with incomplete small bowel obstruction, the elderly were more likely to have adenocarcinoma than the adults (19.4% vs. 7.1%, P = 0.038). The adults had higher tendency to have Crohn's disease than the elderly (23.4% vs. 8.3%, P = 0.045). Most of the postoperative complications were mild. The adults and elderly displayed comparable tolerance to DBE (P > 0.05)

DBE has a high diagnostic yield in small bowel disorders, and a slight difference in disease spectrum was observed between the adults and elderly. DBE can be well-tolerated in the elderly.

• Gastrointestinal bleed
• Minimally-invasive surgery
• Small bowel

• double-balloon enteroscopy
• small bowel metastases
• small bowel tumors
• surgery

• Aged
• Biopsy
• Double-Balloon Enteroscopy/methods
• Female
• Humans
• Ileal Neoplasms/diagnosis
• Ileal Neoplasms/pathology
• Ileal Neoplasms/surgery
• Jejunal Neoplasms/diagnosis
• Jejunal Neoplasms/pathology
• Jejunal Neoplasms/surgery
• Male
• Middle Aged
• Neoplasm Metastasis
• Retrospective Studies

• Diagnostic yield
• Endoscopy
• Small intestine
• Therapeutic yield

• Neuroendocrine tumors
• capsule endoscopy
• double-balloon enteroscopy
• small bowel

• Anemia, Iron-Deficiency/etiology
• Angiography
• Balloon Enteroscopy
• Capsule Endoscopy
• Colonoscopy
• Duodenal Diseases/diagnostic imaging
• Endoscopy, Gastrointestinal
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Ileal Diseases/diagnostic imaging
• Jejunal Diseases/diagnostic imaging
• Magnetic Resonance Imaging
• Tomography, X-Ray Computed

• CT enterography
• CT-enteroclysis
• Capsule endoscopy
• Device-assisted enteroscopy
• MR enterography
• MR-enteroclysis
• Small bowel tumors

Meckel’s diverticulum may sometimes present as an intraluminal polypoid mass causing small bowel obstruction; however, gastrointestinal bleeding due to Meckel’s diverticulum with a polypoid lesion is rare. A 14-year-old girl presented with tarry stool and syncope in our hospital. Laboratory examination showed iron-deficiency anemia with a low hemoglobin level of 5.8 g/dl. The bleeding site was detected by neither upper gastrointestinal endoscopy nor colonoscopy. Transanal double-balloon enteroscopy showed a diverticulum with an ulceration at a site approximately 50 cm from the ileocecal valve and a polypoid lesion inside of the diverticulum. Histopathological examination of a polypoid lesion revealed an ectopic gastric mucosa of the fundic type. Furthermore, technetium-99m pertechnetate scintigraphy showed a hot spot in her lower right abdomen. On the basis of these findings, she was diagnosed as having hemorrhagic Meckel’s diverticulum. Single-incision laparoscopy-assisted segmental bowel resection of the ileum was performed. The patient recovered well, and she was discharged from the hospital on postoperative day 7. She was doing well 6 months later without evidence of reoccurrence. In this report, we describe a case of Meckel’s diverticulum with a polypoid lesion; hemorrhage may have occurred owing to the ulceration of the ileal mucosa with which the polypoid lesion directly came in contact. We consider this case to be of interest to gain insight into the site and mechanism of ulceration associated with Meckel’s diverticulum.

• Double-balloon enteroscopy
• Meckel’s diverticulum
• Polypoid lesion
• Single-incision laparoscopy-assisted surgery

• Capsule Endoscopy
• Endoscopy, Gastrointestinal/methods
• Humans
• Inflammatory Bowel Diseases/drug therapy
• Inflammatory Bowel Diseases/pathology
• Intestinal Mucosa/pathology
• Magnetic Resonance Imaging
• Severity of Illness Index
• Wound Healing

• T32 DK007202 NIDDK NIH HHS
• 5T32DK007202-39 NIDDK NIH HHS

Background. We aimed to evaluate the efficacy of various diagnostic tools such as computerized tomography (CT), small bowel follow-through (SBFT), and capsule endoscopy (CE) in diagnosing small bowel tumors (SBTs). Additionally, we aimed to evaluate the clinical features of SBTs missed by CE. Methods. We retrospectively studied 79 patients with histologically proven SBT. Clinical data were analyzed with particular attention to the efficacy of CT, SBFT, and CE in detecting SBT preoperatively. We also analyzed the clinical features of SBTs missed by CE. Results. The most common symptoms of SBT were bleeding (43%) and abdominal pain (13.9%). Diagnostic yields were as follows: CT detected 55.8% of proven SBTs; SBFT, 46.1%; and CE, 83.3%. The sensitivity for detecting SBTs was 40.4% for CT, 43.9% for SBFT, and 79.6% for CE. Two patients with nondiagnostic but suspicious findings on CE and seven patients with negative findings on CE were eventually found to have SBT. These nine patients were eventually diagnosed with gastrointestinal stromal tumor (4), small polyps (3), inflammatory fibroid polyp (1), and adenocarcinoma (1). These tumors were located in the proximal jejunum (5), middle jejunum (1), distal jejunum (1), and proximal ileum (1). Conclusion. CE is more efficacious than CT or SBFT for detecting SBTs. However, significant tumors may go undetected with CE, particularly when located in the proximal jejunum.

AIM: To compare the roles of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in the diagnosis of obscure small bowel diseases.

METHODS: From June 2009 to December 2014, 88 patients were included in this study; the patients had undergone gastroscopy, colonoscopy, radiological small intestinal barium meal, abdominal computed tomography or magnetic resonance imaging scan and mesenteric angiography, but their diagnoses were still unclear. The patients with gastrointestinal obstructions, fistulas, strictures, or cardiac pacemakers, as well as pregnant women, and individuals who could not accept the capsule-retention or capsule-removal surgery were excluded. Patients with heart, lung and other vital organ failure diseases were also excluded. Everyone involved in this study had undergone CE and DBE. The results were divided into: (1) the definite diagnosis (the diagnosis was confirmed at least by one of the biopsy, surgery, pathology or the drug treatment effects with follow-up for at least 3 mo); (2) the possible diagnosis (a possible diagnosis was suggested by CE or DBE, but not confirmed by the biopsy, surgery or follow-up drug treatment effects); and (3) the unclear diagnosis (no exact causes were provided by CE and DBE for the disease). The detection rate and the diagnostic yield of the two methods were compared. The difference in the etiologies between CE and DBE was estimated, and the different possible etiologies caused by the age groups were also investigated.

RESULTS: CE exhibited a better trend than DBE for diagnosing scattered small ulcers (P = 0.242, Fisher’s test), and small vascular malformations (χ² = 1.810, P = 0.179, Pearson χ² test), but with no significant differences, possible due to few cases. However, DBE was better than CE for larger tumors (P = 0.018, Fisher’s test) and for diverticular lesions with bleeding ulcers (P = 0.005, Fisher’s test). All three hemangioma cases diagnosed by DBE in this study (including sponge hemangioma, venous hemangioma, and hemangioma with hamartoma lesions) were all confirmed by biopsy. Two parasite cases were found by CE, but were negative by DBE. This study revealed no obvious differences in the detection rates (DR) of CE (60.0%, 53/88) and DBE (59.1%, 52/88). However, the etiological diagnostic yield (DY) difference was apparent. The CE diagnostic yield was 42.0% (37/88), and the DBE diagnostic yield was 51.1% (45/88). Furthermore, there were differences among the age groups (χ² = 22.146, P = 0.008, Kruskal Wallis Test). Small intestinal cancer (5/6 cases), vascular malformations (22/29 cases), and active bleeding (3/4 cases) appeared more commonly in the patients over 50 years old, but diverticula with bleeding ulcers were usually found in the 15-25-year group (4/7cases). The over-25-year group accounted for the stromal tumors (10/12 cases).

CONCLUSION: CE and DBE each have their own advantages and disadvantages. The appropriate choice depends on the patient’s age, tolerance, and clinical manifestations. Sometimes CE followed by DBE is necessary.

• Capsule endoscopy
• Double-balloon enteroscopy
• Obscure small intestinal diseases

• Adolescent
• Adult
• Age Factors
• Biopsy
• Capsule Endoscopy
• Chi-Square Distribution
• Double-Balloon Enteroscopy
• Female
• Humans
• Intestinal Diseases/etiology
• Intestinal Diseases/pathology
• Intestine, Small/pathology
• Male
• Middle Aged
• Patient Selection
• Predictive Value of Tests
• Prospective Studies
• Risk Factors
• Young Adult

• Double balloon enteroscopy
• Gastrointestinal stromal tumor
• Malignant small bowel tumors
• Obscure gastrointestinal bleeding
• Occlusion syndrome

• capsule endoscopy
• complications
• double-balloon enteroscopy
• older people

• Age Factors
• Aged, 80 and over
• Double-Balloon Enteroscopy/adverse effects
• Double-Balloon Enteroscopy/statistics & numerical data
• Female
• Gastrointestinal Hemorrhage/diagnosis
• Humans
• Male
• Retrospective Studies
• Treatment Outcome

Since its introduction in 2001 capsule endoscopy opened up the small bowel for diagnostic approaches followed by double balloon enteroscopy which enabled the endoscopic community to perform therapeutic interventions in the whole small intestine. In this review the scientific developments related to indications, diagnostic yield and complications of the last years between the competing devices double ballon enteroscopy, single balloon enteroscopy and spiral enteroscopy are illustrated.

• Deep enteroscopy
• Spiral enteroscopy
• Complications
• Double balloon enteroscopy
• Indications
• Single balloon enteroscopy
• Diagnostic yield

• Double-Balloon Enteroscopy/adverse effects
• Double-Balloon Enteroscopy/instrumentation
• Endoscopes, Gastrointestinal
• Equipment Design
• Humans
• Intestinal Diseases/pathology
• Intestine, Small/pathology
• Predictive Value of Tests