Imaging and Screening of Cancer of the Small Bowel

Clinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile

BACKGROUND

Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America.

AIM

To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs.

METHODS

Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile.

RESULTS

A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1-99.2), 82.2% (95%CI: 57.6-93.3), 40.0% (95%CI: 16.5-82.8) and 25.9% (95%CI: 4.5-55.7%), respectively. NET (HR 6.1; 95%CI: 2.1-17.2) and GIST (HR 24.4; 95%CI: 3.0-19.8) were independently associated with higher survival compared to AC, adjusted for age and sex.

CONCLUSIONS

Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes.

Enteroscopy versus Video Capsule Endoscopy for Automatic Diagnosis of Small Bowel Disorders-A Comparative Analysis of Artificial Intelligence Applications

BACKGROUND

Small bowel disorders present a diagnostic challenge due to the limited accessibility of the small intestine. Accurate diagnosis is made with the aid of specific procedures, like capsule endoscopy or double-ballon enteroscopy, but they are not usually solicited and not widely accessible. This study aims to assess and compare the diagnostic effectiveness of enteroscopy and video capsule endoscopy (VCE) when combined with artificial intelligence (AI) algorithms for the automatic detection of small bowel diseases.

MATERIALS AND METHODS

We performed an extensive literature search for relevant studies about AI applications capable of identifying small bowel disorders using enteroscopy and VCE, published between 2012 and 2023, employing PubMed, Cochrane Library, Google Scholar, Embase, Scopus, and ClinicalTrials.gov databases.

RESULTS

Our investigation discovered a total of 27 publications, out of which 21 studies assessed the application of VCE, while the remaining 6 articles analyzed the enteroscopy procedure. The included studies portrayed that both investigations, enhanced by AI, exhibited a high level of diagnostic accuracy. Enteroscopy demonstrated superior diagnostic capability, providing precise identification of small bowel pathologies with the added advantage of enabling immediate therapeutic intervention. The choice between these modalities should be guided by clinical context, patient preference, and resource availability. Studies with larger sample sizes and prospective designs are warranted to validate these results and optimize the integration of AI in small bowel diagnostics.

CONCLUSIONS

The current analysis demonstrates that both enteroscopy and VCE with AI augmentation exhibit comparable diagnostic performance for the automatic detection of small bowel disorders.

Prediction of distant metastasis and specific survival prediction of small intestine cancer patients with metastasis: A population-based study

BACKGROUND

Small intestine cancer (SIC) is difficult to diagnose early and presents a poor prognosis due to distant metastasis. This study aimed to develop nomograms for diagnosing and assessing the prognosis of SIC with distant metastasis.

METHODS

Patients diagnosed with SIC between 2010 and 2015 were included from the Surveillance, Epidemiology and End Results database. Univariate and multifactor analysis determined independent risk factors for distant metastasis and prognostic factors for overall and cancer-specific survival. We then constructed the corresponding three nomograms and assessed the diagnostic accuracy of the nomograms by net reclassification improvement, receiver operating characteristic curves and calibration curves, assessed the clinical utility by decision curve analysis.

RESULTS

The cohort consisted of 6697 patients, of whom 1299 had distant metastasis at diagnosis. Tstage, Nstage, age, tumor size, grade, and histological type were independent risk factors for distant metastasis. Age, histological type, T stage, N stage, grade, tumor size, whether receiving surgery, number of lymph nodes removed, and the presence of bone or lung metastases were predictors of both overall survival and cancer-specific survival. The nomograms showed excellent accuracy in predicting distant metastasis and prognosis.

CONCLUSION

Nomograms were developed and validated for SIC patients with distant metastasis, aiding physicians in making rational and personalized clinical decisions.

Minimally invasive surgery with adenocarcinoma of jejunum diagnosed pathologically before surgery: A case report

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Adenocarcinoma of jejunum is a very rare malignant tumor worldwide.

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Small intestine cancer is difficult to diagnose histologically before surgery, and whether it is diagnosed before surgery has an important influence on the surgical method.

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Multidisciplinary treatment was conducted to diagnose small intestine cancer and determine treatment options, which is a global trend.

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In this case, the preoperative balloon endoscopy was used to diagnose small intestine cancer histologically, as well as the location of the lesion, so that the operation could be performed by laparoscopy.

Introduction and importance

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

Presentation of case

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.

Clinical discussion

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

Conclusions

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

Bowel Imaging in Children: Part 2

The bowel is a challenging abdominal organ to image. A variety of bowel disorders such as congenital, developmental, inflammatory, infectious and neoplastic lesions can affect children and most of them are either unique to this age group or have a distinct clinico-radiological appearance compared to adults. Imaging forms an integral part of management of these disorders. This article will cover inflammatory/infective, neoplastic and miscellaneous disorders affecting the bowel. The authors will highlight the salient imaging features for those entities.

Bevacizumab in metastatic small-bowel adenocarcinoma: A systematic review and meta-analysis

Cancers of the small bowel could account for less than 5% of all gastrointestinal malignancies. Of these tumors, adenocarcinomas were the major histologic subtype and generally carried a poor prognosis. High expression of vascular epithelial growth factor (VEGF) could be seen in small bowel adenocarcinomas. A systematic review was conducted here to determine if bevacizumab, a recombinant humanized antibody against VEGF, could offer clinical benefit among patients with metastatic small bowel adenocarcinoma when combined with chemotherapy. A search for relevant published and unpublished studies was performed using PubMed, ScienceDirect, Google Scholar, the American Society of Clinical Oncology meetings library, ClinicalTrials.gov, and ISRCTN registry. Information on study design, methods, intervention, and outcomes were extracted from selected eligible studies. Methodological quality was then assessed using the Newcastle-Ottawa Scale. There was a significant improvement in mean overall survival with the addition of bevacizumab with chemotherapy versus chemotherapy alone. The use of bevacizumab with chemotherapy, likewise improved progression-free survival and objective response rate compared to chemotherapy alone. Continued use of bevacizumab beyond first progression also appeared to show benefit. The conduct of prospective controlled studies by consortia to offset the rarity of small bowel adenocarcinomas could further elucidate the efficacy of bevacizumab in the treatment of this disease.

Cinematic rendering of small bowel pathology: preliminary observations from this novel 3D CT visualization method

3D visualization methods for volumetric CT data have played an important role in diagnostic imaging of the small bowel, a structure which intrinsically crosses numerous slices in any 2D imaging plane. Recently, a new approach to 3D CT image creation has become available-cinematic rendering (CR). CR differs from other 3D methods in making use of a global lighting model that produces high surface detail and realistic shadowing effects that lead to 3D visualizations with photorealistic quality. Although the utility of these images for improving diagnostic accuracy has not yet been established, our group's early experience in regions of complex anatomy and pathology has been encouraging. In this pictorial review, we review the established role of 3D CT in many of the most common small bowel pathologies, provide examples of those pathologies visualized with CR, and suggest future directions for researchers to pursue.

[Minimally invasive treatment of rare forms of mechanical intestinal obstruction]

AIM

To develop medical algorithms for reduction of morbidity and mortality in rare forms of mechanical intestinal obstruction.

MATERIAL AND METHODS

17 patients with mechanical intestinal obstruction have been operated in Sklifosovsky Research Institute for Emergency Care for the period 2010 - 2016. There were 13 women and 4 men aged 56 (44,5-74,5) years on the average. Phytobezoar was detected in 7 patients (41.2%), tumor in 7 patients (41.2%) and gallstone ileus in 3 patients (17.6%).

RESULTS

There were no complications in group 1. In group 2 postoperative complications occurred in 3 patients: gastrocnemius vein thrombosis followed by successful medication (Clavien-Dindo type II), abdominal abscess drained under ultrasonic control (Clavien-Dindo type IIIa) and 1 (8.3%) death (Clavien-Dindo type V). Postoperative mortality in group 2 was 8.3%.

CONCLUSION

Despite small sample size and no statistically reliable results the advantages of minimally invasive access are obvious. However, further trials are required to ensure the reliability of the results.