Background:Patients with neuroendocrine tumors(NET)of the small bowel often present with metastatic disease,and localization of the primary tumor still is a diagnostic challenge.Wireless capsule endoscopy(WCE)is an es...Background:Patients with neuroendocrine tumors(NET)of the small bowel often present with metastatic disease,and localization of the primary tumor still is a diagnostic challenge.Wireless capsule endoscopy(WCE)is an established method that improves the diagnostic evaluation of diseases of the small intestine.Objective:The aim of this study was to determine the diagnostic accuracy of WCE in imaging neuroendocrine tumors of the small bowel in these patients.Design:We retrospectively compared the findings of capsule endoscopy to the findings of CT enteroclysis in patients with histopathological confirmation of NET.Patients:Eight patients with newly established diagnosis of metastatic NET were included.Interventions:All patients underwent CT enteroclysis and wireless capsule endoscopy within a maximum of 2 weeks.Main Outcome Measurements:Number of primary tumors detected.The results of surgery were used as a gold standard for both methods.Results:CT enteroclysis detected the primary tumor in 4 of 8 patients whereas WCE found the primary in 3 patients.On the contrary,CT enteroclysis provided more false-positive results.Limitations:Frequent extraluminal tumor growth.Conclusions:In patients with NET,wireless capsule endoscopy may be helpful in individual cases but the general diagnostic value of this method may be limited due to frequent extraluminal growth of these tumors.展开更多
Background and study aims: At many centers wireless capsule endoscopy (WCE) without prior radiographic examination to rule out relevant strictures is considered to be contraindicated in suspected obstructive small- bo...Background and study aims: At many centers wireless capsule endoscopy (WCE) without prior radiographic examination to rule out relevant strictures is considered to be contraindicated in suspected obstructive small- bowel disease. However, the accuracy of radiography in this situation has often been questioned. The purpose of this prospective study was to investigate the feasibility and safety of the recently developed patency capsule, and its predictive value regarding the clinical relevance of radiographic small- bowel strictures. Patients and methods: 22 patients with suspected obstructive small- bowel disease and/or radiological evidence of small- bowel strictures underwent a patency capsule examination. Intact passage, patient experience of pain, and capsule disintegration were correlated with radiographic findings, clinical variables, and outcome. Results: 13 patients passed an intact capsule without complaints, despite radiographically observed small- bowel stenosis; the subsequent video capsule examination was uneventful in all. In nine patients either intact passage was painful or the capsule disintegrated; in one of these, impaction of an intact capsule led to an ileus and emergency surgery. The type of capsule passage did not correlate with radiographic presence of a stricture, underlying diagnosis, or previous surgery. There was a statistically significant correlation between outcome (surgery performed or recommended) and occurrence of painful capsule passage and disintegration (P≤ 0.05). Conclusions: Painless egestion of an intact patency capsule indicates safety of WCE. Patients without obstructive symptoms require neither small- bowel radiography nor a patency capsule study prior to WCE. Disintegration of the patency capsule or painful passage seems to be associated with a clinically relevant small- bowel stricture and with a high probability of surgery.展开更多
文摘Background:Patients with neuroendocrine tumors(NET)of the small bowel often present with metastatic disease,and localization of the primary tumor still is a diagnostic challenge.Wireless capsule endoscopy(WCE)is an established method that improves the diagnostic evaluation of diseases of the small intestine.Objective:The aim of this study was to determine the diagnostic accuracy of WCE in imaging neuroendocrine tumors of the small bowel in these patients.Design:We retrospectively compared the findings of capsule endoscopy to the findings of CT enteroclysis in patients with histopathological confirmation of NET.Patients:Eight patients with newly established diagnosis of metastatic NET were included.Interventions:All patients underwent CT enteroclysis and wireless capsule endoscopy within a maximum of 2 weeks.Main Outcome Measurements:Number of primary tumors detected.The results of surgery were used as a gold standard for both methods.Results:CT enteroclysis detected the primary tumor in 4 of 8 patients whereas WCE found the primary in 3 patients.On the contrary,CT enteroclysis provided more false-positive results.Limitations:Frequent extraluminal tumor growth.Conclusions:In patients with NET,wireless capsule endoscopy may be helpful in individual cases but the general diagnostic value of this method may be limited due to frequent extraluminal growth of these tumors.
文摘Background and study aims: At many centers wireless capsule endoscopy (WCE) without prior radiographic examination to rule out relevant strictures is considered to be contraindicated in suspected obstructive small- bowel disease. However, the accuracy of radiography in this situation has often been questioned. The purpose of this prospective study was to investigate the feasibility and safety of the recently developed patency capsule, and its predictive value regarding the clinical relevance of radiographic small- bowel strictures. Patients and methods: 22 patients with suspected obstructive small- bowel disease and/or radiological evidence of small- bowel strictures underwent a patency capsule examination. Intact passage, patient experience of pain, and capsule disintegration were correlated with radiographic findings, clinical variables, and outcome. Results: 13 patients passed an intact capsule without complaints, despite radiographically observed small- bowel stenosis; the subsequent video capsule examination was uneventful in all. In nine patients either intact passage was painful or the capsule disintegrated; in one of these, impaction of an intact capsule led to an ileus and emergency surgery. The type of capsule passage did not correlate with radiographic presence of a stricture, underlying diagnosis, or previous surgery. There was a statistically significant correlation between outcome (surgery performed or recommended) and occurrence of painful capsule passage and disintegration (P≤ 0.05). Conclusions: Painless egestion of an intact patency capsule indicates safety of WCE. Patients without obstructive symptoms require neither small- bowel radiography nor a patency capsule study prior to WCE. Disintegration of the patency capsule or painful passage seems to be associated with a clinically relevant small- bowel stricture and with a high probability of surgery.
