ABSTRACT
Objective To explore the diagnostic value of capsule endoscopy and small bowel CT virtual endoscopy( CTVE) in identifying of small intestinal diseases. Methods Fifty?five cases patients of suspected small intestinal diseases who were treated by Capsule endoscopy and small bowel CTVE examination in the Affili?ated Hospital of North China University of Science&Technology and Kailuan Majiagou Mine Hospital from Janu?ary 2009 to December 2015 were chosen. The detection rate and diagnostic accuracy of small bowel disease were compared between the two methods. Results There was no significant difference in the detection rate of CTVE and capsule endoscopy( 80. 7% vs. 89. 5%,P=0. 719) . There was significant difference in the accuracy of CTVE and capsule endoscopy in the diagnosis of small intestinal non space occupying lesions ( 60. 7% vs. 89. 3%, P=0. 040) . The correct rate of diagnosis of small bowel lesions was 93. 1% in CTVE,and 51. 7% in capsule en?doscopy,there was statistically significant difference between the two ways( P=0. 032) . Conclusion Capsule endoscopy and CTVE are both non invasive tests,the operation is simple,safe,and the patients are easy to ac?cept,and they are both helpful in the diagnosis of small bowel diseases. Capsule endoscopy has an advantage in the diagnosis of small bowel lesions,while CTVE is superior to capsule endoscopy in terms of small bowel occup?ying lesions. Combined use of the two ways can improve the diagnostic rate of small bowel disease.
ABSTRACT
Objective To evaluate the clinical value of 18F-FDG PET-CT imaging on monitoring recurrence, metastasis and therapeutic decision-making in small intestinal adenocarcinoma patients after radical surgery. Methods Twenty-two patients were enrolled, who underwent surgical operation before received PET-CT scan. PET-CT findings were retrospectively observed to compare with the results of follow-up [postoperative pathology and (or) long-term clinical follow-up]. The roles of PET-CT on therapeutic decision-making were then investigated. Results Among 22 patients, 14 cases were finally diagnosed as recurrence and (or) metastasis, the other 8 cases as disease-free survival after long-term follow-up. According to PET-CT, 13 cases were diagnosed as recurrence and (or) metastasis (including 12 true-positive and 1 false-positive), and 9 cases were negative (including 2 false-negative). The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET-CT were 85.7 % (12/14), 87.5 % (7/8), 86.4 %(19/22), 92.3%(12/13) and 77.8%(7/9), respectively. The therapeutic decisions were changed in 10 patients (10/22, 45.5 % ) based on PET-CT results. Conclusion 18F-FDG PET-CT has an important clinical value on the detection of recurrence and (or) metastasis of small intestinal adenocarcinoma, which is an ideal method of monitoring.
ABSTRACT
Objective To investigate the clinicopathological characteristics,treatment,prognostic factors of primary small intestinal lymphoma (PSIL).Methods The clinical data of 68 patients with PSIL who were admitted to the Cancer Hospital of Tianjin Medical University from November 1999 to July 2009 were retrospectively analyzed.The diagnostic workup before operation included abdominal ultrasound,computed tomography (CT) scan of the abdomen,small intestinal barium radiography,endoscopy examination and laboratory examination.The patients with local PSIL underwent radical surgery,patients who were not eligible for radical surgery received palliative treatment,and then accurate staging was done according to Ann-Arbor system for gastrointestinal lymphoma,and chemotherapy was applied according to the condition of patients.The patients were followed up by letters,telephone and outpatient care till July 2012.Factors might have influence on the prognosis were analyzed by the Kaplan-Meier method and Log-rank test.COX regression model were used for univariate and multivariate analysis,respectively.Results The major symptoms of PSIL included abdominal pain (69.1％,47/68) and weight loss (29.4％,20/68).All of the 68 patients underwent small intestinal barium radiography and endoscopy examination,and 15 and 11 cases were definitely diagnosed as with PSIL.Abdominal mass were detected by abdominal ultrasound in 38 of 45 cases.Positive results were found in 30 cases by CT and 5 cases by positron emission tomography (PET)-CT.PSIL mainly involved ileum (73.5％,50/68),13 PSILs were located at the jejunum and 5 at the duodenum.Of all the 68 patients,64 were with B-cell subtype PSIL and 4 were with T-cell subtype PSIL.Most tumors belonged to stages Ⅰ and Ⅱ (66.2％,45/68).All of the 68 patients were treated with surgical procedure,including 51 patients received radical resection and 17 patients had palliative resection.After operation,4-8 cycles of chemotherapy were applied in 57 patients.Seven patients received COP regimen,50 received CHOP regimen (10 patients with positive expression of CD20 received R-CHOP regimen simutaneously),the remaining 11 patients did not receive chemotherapy.Sixty-four patients were followed up,and the follow-up rate was 94.1％ (64/68).The median follow-up time was 40 months (range,3-132 months).The median survival time was 40.5 months.The 1-,3-,and 5-year overall survival rates were 78.1％,62.2％ and 59.7％,respectively.The prognosis of patients with B-cell subtype PSIL,in stage Ⅰ-Ⅱ and received operation + chemotherapy was superior to those who were with T-cell subtype PSIL,in stage Ⅲ-Ⅳ and received operation (x2=22.459,45.535,15.782,P ＜ 0.05).The results of univariate analysis showed that level of LDH,pathological subtype,clinical stage,presence of systemic symptom,treatment modality,radical surgery and lymphatic metastasis were risk factors for prognosis (x2=7.245,22.459,45.535,5.796,15.782,45.926,9.214,P ＜ 0.05).The results of multivariate analysis revealed B cell phenotype,stage Ⅰ-Ⅱ and surgery + chemotherapy were independent prognostic factors for survival (RR =7.133,5.304,0.256,95％ CI:1.634-31.130,1.498-18.781,0.095-0.691,P ＜ 0.05).Conclusions The major symptoms of PISL include abdominal pain and weight loss.Definite diagnosis of PSIL depends on endoscopy and imaging examination.PSIL mainly involves ileum.Surgery based treatment is the preferred option,and the combined treatment of rituximab with chemotherapy may improve the survival.B-cell phenotype,early clinical stage (Ⅰ-Ⅱ) and surgical resection plus chemotherapy are independent prognostic factors for better survival.
ABSTRACT
Small intestinal neuroendocrine carcinoma is poorly differentiated,highly malignant,and originated from the diffuse neuroendocrine system.It diffusely expresses the general neuroendocrine differentiation markers.The disease can be manifested as carcinoid syndrome,but most of the patients were with occult onset and absence of specific clinical symptoms,which led to difficult diagnosis before operation.On June 18,2012,a patient with manifestation of recurrent vague abdominal pain received capsule endoscopy at the Northern Jiangsu People's Hospital.The capsule endoscope was retained in the distal small intestine,and malignant ileum lesion was revealed during the surgical exploration.Finally,poorly differentiated neuroendocrine carcinoma with abdominal wall metastases was identified by pathological examination.
ABSTRACT
Small intestine tumors are infrequent lesions during the routine clinical practice. They appear sporadically, in association with genetic diseases (e.g familiar adenomatous polyposis or Peutz-Jeghers syndrome), or associated to chronic inflammatory diseases (e.g Crohns disease or celiac disease). Benign tumors of small intestine (e.g leiomyomas, lipomas, adenomas, hamartomas or desmoid tumors) are generally asymptomatic, and may show up with intussusception. Primary malignant small intestine tumors (e.g adenocarcinoma, leiomyosarcoma, carcinoid tumor and lymphoma), can appear with intestinal obstruction, jaundice, digestive bleeding or abdominal pain. Small intestine metastatic lesions can appear by nearness, peritoneal metastasis or by hematological way. This last dissemination type is infrequent and more typically of melanoma. Because of its low prevalence, unspecific symptomatology and relative inaccessibility by conventional endoscopy, the diagnostic of small intestine neoplasm is often made several months after the first symptoms. Enteroclysis is a useful imaging technique towards the small intestine neoplasm suspicion. The endoscopic capsule and enteroscopy are actually the best diagnostic and therapeutic methods for this type of neoplasm. The treatment depends in the type of neoplasm, being the tumoral resection the first-line therapy.
Los tumores de intestino delgado son lesiones infrecuentes en la práctica clínica habitual. Aparecen de forma esporádica en asociación con enfermedades genéticas (por ej., poliposis adenomatosa familiar o síndrome de Peutz-Jeghers), o bien asociados a enfermedades inflamatoria crónicas intestinales (por ej., enfermedad de Crohn o enfermedad celíaca). Los tumores benignos de intestino delgado (por ej., leiomiomas, lipomas, adenoma, hamartoma o tumor desmoide) son generalmente asintomáticos, pudiendomanifestarse con intususcepción. Los tumores malignos primarios de intestino delgado (por ej.,adenocarcinoma, leiomiosarcoma, carcinoide y linfoma), pueden presentarse con obstrucción intestinal, ictericia, sangramiento digestivo o dolor abdominal. Las lesiones metastásicas de intestino delgado pueden aparecer por contigüidad, metástasis peritoneal o por vía hematógena. Este último tipo de diseminación es infrecuente y más típico del melanoma. Debido a su baja prevalencia, sintomatología inespecífica y relativa inaccesibilidad por endoscopía convencional, el diagnóstico de las neoplasias de intestino delgado es realizado a menudo varios meses después de iniciado los síntomas. La enteroclisis es una técnica de imagen útil frente a la sospecha de neoplasia de intestino delgado. La cápsula endoscópica y la enteroscopía son los métodos actualmente de mayor rendimiento para el diagnóstico y eventual terapia de este tipo de neoplasias. El tratamiento depende del tipo de neoplasia, siendo la resección tumoral la terapia de primera línea.