Characteristics of small bowel tumors detected by double balloon endoscopy.

BACKGROUND: A few reports suggest that the emergence of double balloon endoscopy (DBE) has likely changed the clinical picture of small bowel tumors (SBTs). AIM: To further clarify the characteristics of SBTs detected by DBE. METHODS: A retrospective chart review was conducted in 227 patients who had undergone DBE. RESULTS: The SBT group contained more symptomatic patients than the non-SBT group (90% vs. 49%, P<0.0005) with a significantly higher rate of gastrointestinal symptoms at presentation (72% vs. 33%, P<0.005). Twenty patients (8.8%) were eventually diagnosed with SBT, and their indications for DBE were obscure gastrointestinal bleeding (n=5), abdominal pain (n=5), abdominal fullness (n=5), vomiting (n=2), and diarrhea (n=1). Tumors were located in the jejunum in 14 patients (70%) and in the ileum in 6 (30%). A final histological diagnosis was assigned to all 20 patients: primary adenocarcinoma (n=8, 40%), malignant lymphoma (n=5, 25%), metastatic cancer (n=4, 20%), gastrointestinal stromal tumor (n=1, 5%), carcinoid tumor (n=1, 5%) and inflammatory fibroid polyp (n=1, 5%). Stenosis or ulceration were the most frequently observed endoscopic findings (n=13, 65%). All primary adenocarcinomas and three of four (75%) metastatic cancers showed stenosis or ulceration. Three of five (60%) malignant lymphomas showed multiple lymphomatous polyps. All patients but one underwent surgical resection or chemotherapy or both. CONCLUSION: DBE is a safe and useful procedure that enables a precise diagnosis of SBTs.

Characteristic endoscopic features of portal hypertensive enteropathy.

BACKGROUND: Double-balloon endoscopy (DBE) and capsule endoscopy have opened up a new field of investigation regarding the small intestine. Although DBE has been widely used for diagnosis and treatment of different lesions in the small intestine, there is a paucity of information regarding endoscopic features of the small intestine in patients with liver cirrhosis (LC). METHODS: Endoscopic images of the small intestine were taken in 21 patients with LC by DBE (EN-450P5/20 or EN-450T5/W). Biopsy specimens were taken from various parts of the small intestine and examined microscopically. Different endoscopic features of the small intestine were compared in relation to the clinical parameters of these patients. RESULTS: Erythema and telangiectasia were observed in five patients (24%) and one patient (5%), respectively. In eight patients (38%), the small intestinal mucosa was edematous, and the intestinal villi of these patients were swollen and rounded, resembling herring roe. The patients with a herring roe appearance in the small intestine had advanced LC (Child's classification B and C), and all of them also had portal hypertensive gastropathy and portal hypertensive colopathy. In comparison with patients without a herring roe appearance in the small intestine, patients with a herring roe appearance had a significantly increased spleen volume (P<0.05) and decreased platelet counts (P<0.05). CONCLUSIONS: Although preliminary, this study indicated that DBE may be useful for detecting different types of endoscopic lesions in patients with LC. A herring roe appearance seems to be one of the characteristic features of portal hypertensive enteropathy. However, further study will be required to develop insights about its pathogenesis.

Extensive liver metastasis of gastric cancer effectively treated by hepatic arterial infusion of 5-fluorouracil/cisplatin.

Most gastric cancer patients with jaundice caused by extensive liver metastasis show no tumor shrinkage response to systemic chemotherapy, while often showing severe adverse reactions. Their prognosis is very poor. We experienced two patients for whom hepatic arterial infusion (HAI) of 5-fluorouracil (5-FU) and cisplatin through an implantable port was effective for treating extensive liver metastasis. One patient had jaundice (serum bilirubin level before HAI therapy, 12.4 mg/dl) caused by metachronous liver metastasis, and prior systemic chemotherapy with 5-FU and irinotecan had not been effective. The other patient had gastric cancer with synchronous liver metastasis and also exhibited jaundice (serum bilirubin level before HAI therapy, 11.8 mg/dl). Both patients were treated with HAI of cisplatin, 20 mg/m(2) for 30 min on day 1, and continuous intraarterial infusion of 5-FU, 300 mg/m(2), from day 1 to day 4 every week. Their metastatic liver tumors were significantly reduced in volume and the jaundice disappeared. They survived for 30 and 27 weeks, respectively. A pharmacokinetic study conducted during the period of partial remission revealed that the extraction ratios of 5-FU and cisplatin in the liver were 0.89 and 0.024, respectively, suggesting a favorable first-pass effect of 5-FU. Although our findings here suggest that the successful local control of liver metastasis could improve the deteriorated condition and prolong the survival in some patients with far advanced cancer, it is essential to pay much attention to possible adverse effects during the treatment.