Introduction Small bowel malignancies are uncommon worldwide and account for only 1–2% of all gastrointestinal malignancies.1 However there is evidence of the rising incidence of small bowel malignancies through the last decades, with increases as high 2.3 per 100 000 population from 1973 to 20042.2-3 We sought to investigate the number of small bowel malignancies diagnosed by double balloon enteroscopy (DBE) and the 1 year outcomes at our institution.
Methods We retrospectively reviewed all the DBEs performed at our UK tertiary centre from 2009 to 2015. Demographics, indications for DBE investigation, prior investigations, DBE findings and 12 month mortality were analysed.
Results 294 DBEs were performed where 19 small bowel cancers were discovered. The original symptoms were anaemia (83.3%, n = 15), vomiting (11.1%, n = 2), and weight loss (5.6%, n = 1). All patients had undergone radiological imaging (76.5%, n = 13) or capsule endoscopy (58.8%, n = 10) prior to DBE. In 33.3% (n = 6) both radiological imaging and capsule endoscopy had been performed. The indication for DBE was abnormal capsule (41.2%, n = 7), abnormal imaging (52.9%, n = 9) and abnormal capsule and imaging (5.9%, n = 1). The histology findings were jejunal adenocarcinoma in 52.9% (n = 9), distal duodenal adenocarcinoma in 29.4% (n = 5), jejunal GIST in 11.8% (n = 2) and enteropathy associated T cell lymphoma in 5.9% (n = 1). 11 patients (57.9%) had capsule endoscopy prior to DBE, capsule endoscopy failed to diagnoses a malignancy in 3 patients (27.3%) who were subsequently found to have a malignancy on DBE (2 patients with Jejunal GIST and 1 patient with jejunal adenocarcinoma). In these 3 patients the capsule finding was reported as showing angiodysplasia. All the malignancies were deemed suitable for therapy by a multidisciplinary team. The treatment was surgery alone in 52.9% (n = 9), surgery and chemotherapy in 23.5% (n = 4) and chemotherapy alone in 17.6% (n = 3). The survival rate at 3 months was 88.2% and 66.7% at 1 year. In the patients with a diagnosis of adenocarcinoma the 1 year survival rate was 85.7%.
Conclusion The 1 year survival of 85.7% is significantly higher than previous reports (survival rate of 30% at 1 year from small bowel adenocarcinoma)4 and may reflect the improved outcomes from earlier diagnosis using capsule and DBE. DBE also aided in the diagnosis of tumours not seen on video capsule endoscopy, as described in literature.5
References 1 Chow JS, et al. Int J Epidemiol 1996;35:722–728
2 Haselkorn T, et al. Cancer Causes Control. 2005;16:781–7.
3 Shack LG, et al. Aliment Pharmacol Ther. 2006;23:1297–306.
4 MH Fargat, A Shamseddine and K Barada. Small Bowel Tumours: Clincial presentation, prognosis and outcomes in 33 patients in a tertiary care centre. Journal of Oncology 2008.
5 Chong AK, et al. Gastrointest Endosc. 2006;64:445–9.
Disclosure of Interest None Declared