Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://www.gastrores.org

Original Article

Volume 15, Number 6, December 2022, pages 353-363


Clinical Features and Management of Small Bowel Masses Detected During Device-Assisted Enteroscopy: A Multi-Center Experience

Figures

Figure 1.
Figure 1. Lesion histology frequency (%). GIST: gastrointestinal stromal tumor; NET: neuroendocrine tumor; GI: gastrointestinal.
Figure 2.
Figure 2. Representative endoscopic images of different small bowel mass lesions detected on device-assisted enteroscopic exams. NET: neuroendocrine tumor; GIST: gastrointestinal stromal tumor.
Figure 3.
Figure 3. Representative biopsy histologic slides of the two most common small bowel mass lesion pathologies diagnosed on device-assisted enteroscopic exams in our study. The slide to the left shows a well-differentiated NET. The slide to the right shows a hamartoma. NET: neuroendocrine tumor.

Tables

Table 1. Patient Characteristics
 
All patients (n = 218)
Frequency (%)
Values are n (%) unless otherwise specified. BMI: body mass index; GI: gastrointestinal.
Age, years (median (Q1, Q3))63 (47, 71)
Gender
  Female100 (45.9)
  Male118 (54.1)
BMI at diagnosis (kg/m2)
  < 18.54 (1.8)
  18.5 - 24.951 (23.4)
  25 - 29.964 (29.4)
  30 - 39.969 (31.7)
  > 4019 (8.7)
  Unknown11 (5.0)
Race
  Caucasian149 (68.3)
  African American50 (22.9)
  Other8 (3.7)
  Unknown11 (5.0)
Family history GI malignancies
  Yes38 (17.4)
  Colorectal cancer29 (13.3)
  Gastric cancer5 (2.3)
  Small bowel cancer6 (2.8)
  Pancreatic cancer2 (0.9)
  Multi-site GI cancer1 (0.5)
  No180 (82.6)
History of hereditary cancer or polyposis syndrome
  No171 (78.4)
  Peutz-Jeghers syndrome40 (18.3)
  Familial adenomatous polyposis3 (1.4)
  Other3 (1.4)
  Unknown1 (0.46)
Tobacco use
  Former51 (23.4)
  Current17 (7.8)
  No144 (66.1)
  Unknown5 (2.3)

 

Table 2. Presenting Symptoms
 
All patients (n = 218)
Frequency (%)
Values are n (%) unless otherwise specified.
Presenting symptoms
  Iron-deficiency anemia/bleeding160 (73.4)
  Abnormal imaging study73 (33.5)
  Abdominal pain27 (12.4)
  Diarrhea24 (11.0)
  Weight loss8 (3.7)
  Bowel obstruction7 (3.2)
  Constitutional symptoms4 (1.8)
  Other31 (14.2)
Duration of presenting symptoms (months)
  < 118 (8.3)
  1 - 655 (25.7)
  6 - 1217 (7.8)
  > 1275 (34.4)
  Unknown52 (23.9)

 

Table 3. Prior Diagnostic Studies and Correlation With DAE Findings
 
All patients (n = 218)
Values are n (%) unless otherwise specified. aPositive finding that correlated to final DAE findings/location. bN = 176 due to information on 42 patients missing or unknown. cMissing information. DAE: device-assisted enteroscopy; EGD: esophagogastroduodenoscopy; VCE: video capsule endoscopy; CT: computed tomography; CTE: computed tomography enterography; MRI: magnetic resonance imaging; MRE magnetic resonance enterography; DBE: double-balloon enteroscopy; SBE: single-balloon enteroscopy; SE: spiral enteroscopy.
EndoscopyOverall (n = 218)Positive findinga, b
  EGD136 (62.4)-c
  Ileo-colonoscopy126 (57.8)2 (1.6)
  Push enteroscopy21 (9.6)6 (28.6)
  VCE156 (71.6)131 (84.0)
  Antegrade DAE10 (4.6)-c
  Retrograde DAE2 (0.9)-c
Radiology
  CT45 (20.6)22 (49)
  CTE18 (8.3)11 (61)
  MRI/MRE2 (0.9)0 (0)
  Unknown19 (8.7)-
DAE modality used to find lesionAll patients (n = 218)
  Antegrade DBE122 (56.0)
  Retrograde DBE65 (29.8)
  Antegrade SBE11 (5.0)
  Retrograde SBE1 (0.5)
  Antegrade SE19 (8.7)

 

Table 4. Lesion Characteristics
 
All patients (n = 218)
Frequency (%)
Values are n (%) unless otherwise specified. aIndicates benign epithelial tumors (e.g., adenoma, hamartoma, Brunner gland lesions). bIndicates malignant epithelial tumors (e.g., carcinoid and adenocarcinoma). cIndicates mesenchymal tumors (e.g., lipoma, liposarcoma, GIST, leiomyoma, hemangioma, etc.) dIndicates lymphoproliferative disorders (e.g., B-cell and T-cell lymphomas). GIST: gastrointestinal stromal tumor.
Lesion location
  Duodenum30 (13.8)
  Jejunum101 (46.3)
  Ileum108 (49.5)
  Multi-site7 (3.2)
  Small bowel (unspecified)0 (0)
Lesion size (mm)
  1 - 56 (2.8)
  5 - 1061 (28.0)
  10 - 20102 (46.8)
  > 2048 (22.0)
  Missing1 (0.5)
Lesion phenotype
  Submucosal90 (41.3)
  Mucosal: sessile32 (14.7)
  Mucosal: pedunculated72 (33)
  Obstructing/invasive24 (11)
Lesion histology
  Benign epitheliala81 (37.2)
  Malignant epithelialb62 (28.4)
  Mesenchymalc35 (16.1)
  Lymphoproliferatived3 (1.4)
  Inflammatory17 (7.8)
  Normal small bowel tissue6 (2.8)
  Vascular13 (6.0)
  Missing1 (0.5)

 

Table 5. Descriptive Characteristics by Histology
 
Carcinoid/NET (N = 45)Hamartoma (N = 45)Hyperplastic (N = 22)Total (N = 217)aP value
aChi-square test. bKruskal-Wallis test. cFisher exact test. aNote one patient did not have any histologies indicated and is excluded from this table. Furthermore, descriptive characteristics of the three most common histologies are represented in this table. FH: family history; GI: gastrointestinal; SD: standard deviation.
Gender0.690a
  Male26 (57.8%)21 (46.7%)13 (59.1%)117 (53.9%)
  Female19 (42.2%)24 (53.3%)9 (40.9%)100 (46.1%)
Age< 0.001b
  N454222212
  Mean (SD)61.13 (13.59)40.33 (17.89)63.32 (12.27)58.94 (17.25)
  Median6436.565.563
  Q1, Q349.00, 69.0027.00, 52.0058.00, 71.0047.00, 71.00
  Range25.00 - 86.0014.00 - 87.0032.00 - 78.0014.00 - 89.00
BMI at diagnosis0.013a
  Missing27111
  < 18.51 (2.3%)0 (0.0%)0 (0.0%)4 (1.9%)
  18.5 - 24.97 (16.3%)19 (50.0%)6 (28.6%)51 (24.8%)
  25 - 29.916 (37.2%)7 (18.4%)2 (9.5%)64 (31.1%)
  30 - 39.916 (37.2%)9 (23.7%)11 (52.4%)69 (33.5%)
  > 403 (7.0%)3 (7.9%)2 (9.5%)18 (8.7%)
Ethnicity0.002c
  Missing2 (0.92%)2 (0.92%)1 (0.46%)
  Caucasian26 (60.5%)36 (83.7%)12 (57.1%)148 (71.8%)
  African American14 (32.6%)4 (9.3%)9 (42.9%)50 (24.3%)
  Hispanic0 (0.0%)3 (7.0%)0 (0.0%)4 (1.9%)
  Native American0 (0.0%)0 (0.0%)0 (0.0%)1 (0.5%)
  Other3 (7.0%)0 (0.0%)0 (0.0%)3 (1.5%)
Polyposis syndrome< 0.001c
  Any history0 (0.0%)39 (86.7%)1 (4.5%)47 (21.7%)
  No history45 (100.0%)6 (13.3%)21 (95.5%)170 (78.3%)
FH of GI malignancies0.010c
  Any history9 (20.0%)14 (31.1%)5 (22.7%)38 (17.5%)
  No history36 (80.0%)31 (68.9%)17 (77.3%)179 (82.5%)

 

Table 6. Post-DAE Lesion Management
 
All patients (n = 218)
Frequency (%)
Values are n (%) unless otherwise specified. DAE: device-assisted enteroscopy.
Endoscopic surveillance49 (22.5)
Surgical resection82 (37.6)
Medical oncology15 (6.9)
Unknown23 (10.6)
No further management57 (26.1)
Other3 (1.4)

 

Table 7. DAE Intervention
 
All patients (n = 218)
Frequency (%)
Values are N (%) unless otherwise specified. DAE: device-assisted enteroscopy.
Tattoo143 (65.6)
Biopsy132 (60.6)
Endoscopic resection83 (38.1)
Clip for marking7 (3.2)
Other3 (1.4)
DAE-related complications2 (0.92)