Jiro Kawashima, Shin-Ei Kudo, Noriyuki Ogata, Yasuharu Maeda, Keisuke Sasabe, Yurie Kawabata, Takanori Kuroki, Yosuke Minegishi, Taishi Okumura, Yuta Kouyama, Tatsuya Sakurai, Kenta Nakahara, Katsuro Ichimasa, Masashi Misawa, Takemasa Hayashi, Naruhiko Sawada, Toshiyuki Baba, Kazuo Ohtsuka
In this malignant SBT cohort, SBE provided clinically useful information for lesion localization, histological confirmation, and treatment planning. Diagnostic surgery was avoided in 75.6% of lesions; however, this descriptive workflow finding should not be interpreted as a demonstrated causal effect of SBE.
BACKGROUND: Accurate pre-treatment characterization of small bowel tumors (SBTs) is essential because therapeutic strategies differ markedly by pathology. Although single-balloon enteroscopy (SBE) enables direct visualization, localization, and biopsy, its clinical utility for treatment planning in malignant SBTs remains insufficiently characterized.
METHODS: This retrospective single-center study included patients who underwent SBE for suspected SBTs between September 2005 and July 2024, excluding hereditary polyposis syndromes. The analysis was restricted to malignant lesions; therefore, diagnostic-performance indices were not estimated. Outcomes were establishment of an SBE-derived pre-treatment diagnosis, concordance among these lesions, lesion reach rate, biopsy yield, tattooing rate, and avoidance of surgery required for diagnosis.
RESULTS: Among 1407 SBE examinations in 1089 patients, 86 malignant lesions in 85 patients were analyzed. The most common indication was obscure gastrointestinal bleeding (36.0%). Malignant lymphoma was most frequent (40.7%), followed by adenocarcinoma (22.1%), gastrointestinal stromal tumor (18.6%), and metastatic carcinoma (12.8%). The target lesion was reached in 84.9% (73/86). An SBE-derived pre-treatment diagnosis was established in 75.6% (65/86), with 95.4% (62/65) concordance with the final diagnosis. Biopsy yielded pathological confirmation in 92.9% (52/56); the intention-to-diagnose yield was 60.5% (52/86). Tattooing was performed in 65.6% (40/61) of treated lesions overall and 83.3% (40/48) of reached treated lesions. Diagnostic surgery was avoided in 75.6% (65/86) of lesions overall and 82.9% (29/35) of malignant lymphoma lesions.
CONCLUSIONS: In this malignant SBT cohort, SBE provided clinically useful information for lesion localization, histological confirmation, and treatment planning. Diagnostic surgery was avoided in 75.6% of lesions; however, this descriptive workflow finding should not be interpreted as a demonstrated causal effect of SBE.