Small-Bowel Tumors Diagnosed And Treated By Double-Balloon Endoscopy: Report Of Twelve Cases

BKG: Small-bowel tumors are relatively rare, and early diagnosis is difficult. Our team has developed a new endoscopic method, double-balloon endoscopy that provides improved access to the deep small intestine. Twelve patients with small-bowel tumors were identified from 1999 to 2003 at Jichi Medical School, Tochigi Japan. AIM: To assess the diagnostic and therapeutic impact of double-balloon endoscopy in 12 patients with small-bowel tumors. METHODS: Double-balloon endoscopy (Fujinon EN-450P TYPE20) was used in this study. Diagnostic yields, therapeutic capabilities, tumor location, and complication rate were determined in 12 patients with small-bowel tumors. RESULTS: Eight (67%) males and four (34%) females were examined. Five (41%) patients presented with rectal bleeding, five (41%) patients with anemia, one (10%) patient with diarrhea and one (10%) patient with a palpable abdominal mass. The median age was 64.5 (41-85) years. All of the 12 small-bowel tumors were visualized using double-balloon endoscopy. The pathological diagnoses were made by biopsies and included 4 (33%) adenocarcinomas, 3 (23%) gastrointestinal stromal tumors (GIST), 2 (17%) malignant lymphomas, 2 (17%) large cell carcinomas and 1 (10%) inflammatory myofibroblastic tumor (IMT). One adenocarcinoma was cured by endoscopical mucosal resection (EMR). Two adenocarcinomas, 3 GIST, 2 large cell carcinomas and 1 IMT were resected surgically. The patients with malignant lymphoma received adjuvant therapy. The exact location of the tumors within the small intestine was determined for all patients. This included 3 (23%) tumors in the duodenum, 6 (50%) tumors in the jejunum, 3 (23%) in the ileum. There were no serious complications in this series. CONCLUSIONS: The double-balloon endoscopy was used successfully for the pathological diagnosis and endoscopic treatment of tumors in the small intestine. These results suggest that this new method is useful for diagnosis and treatment of the small-bowel tumors.