Characteristics and prognosis of small bowel tumors:A retrospective study

BACKGROUND Small bowel tumors(SBTs)are a heterogeneous group of difficult-to-diagnose tumors that account for 2%-5%of all gastrointestinal tumors.Single-balloon enteroscopy greatly enhances the diagnosis and treatment of SBTs.However,few epidemiological studies have been conducted in Taiwan to determine the clinical profile of SBTs.AIM To investigate the clinical characteristics,managements and prognosis of SBTs in a medical center in Taiwan.METHODS The study enrolled 51 patients aged 58.9±8.8 years(range,22-93)diagnosed with SBTs from November 2009 to July 2021.We retrospectively recorded clinical characteristics,indications,endoscopic findings,pathological results,management,and outcomes for further analysis.RESULTS A male preponderance was observed(56.8%).The most common indications were suspected small intestinal tumors(52.9%)and obscure gastrointestinal bleeding(39.2%).The most common tumor location was the ileum(41.2%).The performance of imaging studies(P=0.004)and the types of findings(P=0.005)differed significantly between malignant and benign SBTs.The most frequent imaging finding was a small intestinal mass(43.1%).The top three malignant tumor types were gastrointestinal stromal tumors(GISTs),adenocarcinomas,and lymphomas.Moreover,the proportions of benign and malignant tumors were 27.5%and 72.5%,respectively.The survival rates of patients with malignant tumors in the GIST and non-GIST groups differed significantly(P=0.015).Kaplan–Meier survival analysis showed a significant difference in survival between patients in the malignant and benign groups(P=0.04).All patients with lymphoma underwent chemotherapy(n=7/8,87.5%),whereas most patients with GISTs underwent surgery(n=13/14,92.8%).CONCLUSION Patients with GISTs have a significantly higher survival rate than those with other malignant SBTs.Therefore,a large-scale nationwide study is warranted to evaluate the population-based epidemiology of SBTs.

Emergent single-balloon enteroscopy for overt bleeding of small intestinal vascular malformation

A 28-year-old man presented with anemia symptoms and intermittent tarry stool passage for three days. No stigmata of hemorrhage were identified using esophagogastroduodenoscopy, ileocolonoscopy, and contrast-enhanced computed tomography. He then developed massive tarry stool passage with profound hypovolemic shock and hypoxic respiratory failure. Emergent angiography revealed active bleeder, probably from the jejunal branches of the superior mesenteric artery, but embolization was not performed due to possible subsequent extensive bowel ischemia. His airway was secured via endotracheal intubation with ventilator support, and emergent antegrade singleballoon enteroscopy was performed at 8 h after clinical overt bleeding occurrence; the procedure revealed a 2-cm pulsating subepithelial tumor with a protrudingblood plug at the distal jejunum. Laparoscopic segmental resection of the jejunum with end-to-end anastomosis was performed after emergent endoscopic tattooing localization. Pathological examination revealed a vascular malformation in the submucosa with an organizing thrombus. He was uneventfully discharged 5 d later. This case report highlights the benefit of early deep enteroscopy for the treatment of small intestinal bleeding.

Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy

Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology,but advancements in endoscopic and radiologic imaging modalities allow for greater accuracyin diagnosing obscure gastrointestinal bleeding.Ectopic varices account for less than 5% of all variceal bleeding cases,and jejunal variceal bleeding due to extrahepatic portal hypertension is rare.We present a 47-year-old man suffering from obscure gastrointestinal bleeding.Computed tomography of the abdomen revealed multiple vascular tufts around the proximal jejunum but no evidence of cirrhosis,and a visible hypodense filling defect suggestive of thrombus was visible in the superior mesenteric vein.Enteroscopy revealed several serpiginous varices in the proximal jejunum.Serologic data disclosed protein C deficiency(33.6%).The patient was successfully treated by therapeutic balloonassisted enteroscopy and long-term anticoagulant therapy,which is normally contraindicated in patients with gastrointestinal bleeding.Diagnostic modalities for obscure gastrointestinal bleeding,such as capsule endoscopy,computed tomography enterography,magnetic resonance enterography,and enteroscopy,were also reviewed in this article.

Correlation between colonic secretion and colonic motility in rats: Role of ghrelin

AIM To explore the relationship between colonic secretory function and colonic motility.METHODS Using a rat model chronically implanted with intracerebroventricular(ICV) and cecal catheters, we validated the correlation between colonic secretion and colonic motor functions, as well as the role of ICV injection volume.RESULTS Compared to saline controls(5 μL/rat), ICV acyl ghrelin at 1 nmol/5 μL enhanced the total fecal weight, accelerated the colonic transit time, and increased the fecal pellet output during the first hour post-injection, while ICV des-acyl ghrelin at 1 nmol/5 μL only accelerated the colonic transit time. These stimulatory effects on colonic motility and/or secretion from acyl ghrelin and des-acyl ghrelin disappeared when the ICV injection volume increased to 10 μL compared with saline controls(10 μL/rat). Additionally, the ICV injection of 10 μL of saline significantly shortened the colonic transit time compared with the ICV injection of 5 μL of saline. The total fecal weight during the first hour post-injection correlated with the colonic transit time and fecal pellet output after the ICV injection of acyl ghrelin(1 nmol/5 μL), whereas the total fecal weight during the first hour post-injection correlated with the fecal pellet output but not the colonic transit time after the ICV injection of des-acyl ghrelin(1 nmol/5 μL).CONCLUSION Colonic secretion does not always correlate with colonic motility in response to different colonic stimulations. Acyl ghrelin stimulates colonic secretion.