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MALIGNANT SMALL BOWEL NEOPLASMS – THE TWENTY-YEAR EVOLUTIVE EXPERIENCE IN A TERTIARY CENTER

Ana Teresa Ferreira 1, Joana Mesquita 2, Marta Lemos Rocha 1, Sara Archer 1, Sofia Ponte 1, Isabel Pedroto 1, Marta Salgado 1

Affiliations

1 Centro Hospitalar Universitário de Santo António, Porto, Portugal

2 Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal

Summary

AI Generated

A 20-year retrospective study of 135 patients with malignant small bowel neoplasms found that 65.9% were diagnosed in the last decade, with neuroendocrine tumors becoming the most frequently diagnosed histological type in recent years.

Among 135 patients, adenocarcinomas were the most common histological type overall (31.1%), followed by neuroendocrine tumors (28.1%), gastrointestinal stromal tumors (17.8%), and metastases from other carcinomas (12.6%).
The majority of patients (80.7%) were symptomatic at diagnosis, with 55.4% presenting with severe complications including abdominal occlusion (29.6%), hemorrhage (19.3%), or intestinal perforation (7.4%).
The diagnosis of each histological neoplasm type differed significantly over time (p=0.016), with neuroendocrine tumors being most diagnosed between 2011-2020 (37.1%) while adenocarcinomas predominated between 2001-2010 (37.0%).
Adenocarcinomas had a higher case-fatality rate (54.8% died from this cause) compared to neuroendocrine tumors (7.9% died from this cause).
CT imaging was the most common diagnostic method (40.7%), though 22.2% of patients still required surgery for diagnosis despite advances in complementary diagnostic methods.

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Abstract

Introduction

Malignant small bowel neoplasms (MSBN) are rare entities, whose knowledge is even more limited due to their histological diversity and difficulty in their investigation. Studies show that the incidence of MSBN has been growing in recent decades; thus, interest in these neoplasms has increased in parallel with their rising incidence.

Aims & Methods

The aim of this study was to describe the demographic and clinical characteristics of patients with malignant neoplasms of duodenum, jejunum, and ileum, but also the evolution in the diagnosis of these neoplasms over 20 years.
Retrospective study of patients with MSBN diagnosed between 2001 and 2020 in a tertiary hospital was performed. Demographic and clinical data were collected. Statistical analysis was performed with SPSS vs 29.0 (significance level of 5%).

Results

A total of 135 patients were evaluated. Fifty-seven percent of patients (n=77) were male; the mean age at diagnosis was 64.2 years [diagnosis between 27-91 years]. The mean age at diagnosis showed no statistically significant relationship with the histological subtype (p=0.644).
Most neoplasms were found in the jejunum/ileum (65.9%, n=89). The most frequently diagnosed neoplasms were adenocarcinomas (31.1%, n=42), followed by neuroendocrine tumors (28.10%, n=38), gastrointestinal stromal tumors (GIST) (17.8%, n=24) and metastases from other carcinomas (12.6%, n=17); lymphomas accounted for 5.9% of cases (n=8) and other primary malignancies accounted for 4.4% of cases (n=6).
The majority of patients (80,7%, n= 109) were symptomatic at time of diagnosis - 29.6% (n=40) had abdominal occlusion at diagnosis; 19.3% (n=26) of patients had hemorrhage as the initial clinical presentation, and 7.4% (n=10) of patients had intestinal perforation. It’s also worth mentioning that almost half of the patients (43.7%, n=59) had anemia at diagnosis.
A regular CT was the exam that documented the neoplasm in 40.7% of cases (n=55); an upper digestive endoscopy identified the neoplasm in 22.2% of patients (n=30) and a video capsule endoscopy was necessary for diagnosis in 8.1% of cases (n=11); however, 22.2% of patients (n=30) still required surgery for making the diagnosis; the remaining patients (6.7%, n=9) were diagnosed using other complementary diagnostic methods (CDM).
It should be noted that most diagnoses were made between 2011 and 2020 (65.9%, n=89). Between 2011 and 2020, the most frequently diagnosed MSBN were neuroendocrine tumors (37.1%, n=33), whereas between 2001 and 2010, the most common diagnosed tumors were adenocarcinomas (37.0%, n=17). The diagnosis of each histological neoplasm type differed significantly statistically over the years (p=0.016).
More than half of the patients with adenocarcinoma of the small intestine died from this cause (54.8%, n=23), but only 7.9% (n=3) of the neuroendocrine tumors of the small intestine were the cause of death.

Conclusion

Although these are rare tumors, the sample of MSBN from this tertiary center over these 20 years has still been substantial. Most patients were symptomatic at diagnosis - with severe complications (occlusion, hemorrhage, perforation) in 55.4% of the cases, despite advances in CDM over the years. In this study, 65.9% of MNDJI were diagnosed in the last 10 years of the follow-up, which validates the growing incidence of small bowel neoplasms described in the literature. Noteworthy, the diagnosis of each histological neoplasm type differed significantly statistically over the years (p=0.016), with neuroendocrine tumors being the most diagnosed in recent years.

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 03 Small intestinal (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction: AI integration in my clinical practice today

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Introduction: AI integration in my clinical practice today

Yuichi Mori 1

Affiliations

1 University of Oslo / Showa University, Oslo, Norway

Summary

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Endoscopy

Session

AI integration in my clinical practice today

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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From scope to bedside: AI in direct patient care

Giulio Antonelli 1

Affiliations

1 Ospedale dei Castelli, Rome, Italy

Summary

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Endoscopy

Session

AI integration in my clinical practice today

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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PREOPERATIVE EVALUATION OF LYMPH NODES OF RESECTABLE CHOLANGIOCARCINOMA BY ENDOSCOPIC ULTRASOUND: THE POELH TRIAL

David M. de Jong 1, Willem Lammers 1, Dieke C. Booij 1, Akin Inderson 2, Jeanin van Hooft 2, Andries E. Braat 2, Joep de Bruijne 3, Leon M.G. Moons 3, Jeroen Hagendoorn 3, Jan Werner Poley 4, Maxime Dewulf 4, Frederike G. I. van Vilsteren 5, Wouter B. Nagengast 5, Frederik J.H. Hoogwater 5, Roy LJ van Wanrooij 6,7, Rogier P. Voermans 7,6, Joris I. Erdmann 6, Pieter Hindryckx 8, Suzane Ribeiro 8, Hasan H. Eker 8, Jeroen de Jonge 1, Wojciech G. Polak 1, Michael Doukas 1, Roy S. Dwarkasing 1, Bas Groot Koerkamp 1, Marco J. Bruno 1, Lydi van Driel 1

Affiliations

1 Erasmus MC University Medical Center, Rotterdam, Netherlands

2 Leiden University Medical Center, Leiden, Netherlands

3 University Medical Center Utrecht, Utrecht, Netherlands

4 Maastricht University Medical Center, Maastricht, Netherlands

5 University Medical Center Groningen, Groningen, Netherlands

6 Amsterdam University Medical Center, Amsterdam, Netherlands

7 Cancer Center Amsterdam, Amsterdam, Netherlands

8 University Hospital Ghent, Ghent, Belgium

Summary

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Abstract

Introduction

Lymph node (LN) metastases are a poor prognostic factor for both intrahepatic cholangiocarcinoma (iCCA) and perihilar cholangiocarcinoma (pCCA). Extraregional LN metastases (LNM) preclude surgical exploration, while accurate detection of regional LNM is essential when weighing risks and benefits of surgical resection. Endoscopic ultrasound (EUS) offers the possibility of direct tissue acquisition (TA) of LN. This prospective study aims to assess the yield and clinical impact of preoperative systematic EUS for LN staging in resectable iCCA and pCCA.

Aims & Methods

In this prospective, multicenter trial, patients with presumed resectable iCCA or pCCA from seven tertiary centers (Netherlands/Belgium) were enrolled. Patients without intrapancreatic tumor ingrowth on imaging underwent systematic EUS with sampling of all LNs ≥5 mm short-axis, covering abdominal LN stations 8–18 per the Japanese classification. The primary outcome was the yield, defined as the rate of patients with LNM or other important findings for further work-up, and clinical impact of EUS, defined as preclusion of surgery or alteration of surgical strategy. Secondary outcomes included the LNM “miss” rate at surgery and EUS-related adverse events, according to the AGREE classification. The trial was registered at ClinicalTrials.gov (NCT05678218).

Results

A total of 256 patients were included (59% male, median age of 68 years), comprising 63 iCCA and 193 pCCA patients. LNs were identified on cross-sectional imaging in 71% of patients. Across 286 EUS procedures, 1277 LNs were identified and 424 (33%) sampled, revealing LNM in 75 LN (59 regional, 16 extraregional) in 44 patients. Of the LNM identified by EUS-TA, 57% had been labeled pathological on prior imaging, 13% benign, and 29% were not described.

In 62 patients EUS yielded important findings (24.2%): LNM in 44, pancreatic ingrowth in 14, and single cases of IgG4-cholangiopathy, adrenal metastases, pancreatic cancer, and lymphoma. EUS affected clinical decision making in 49 patients (19.1%): precluding surgery in 43 patients (16.8%) and altering the surgical plan in 6 patients (due to pancreatic ingrowth). In twelve patients regional LNM were identified but surgery was pursued regardless.

Among the 156 patients who proceeded to surgical exploration without EUS-TA proven LNM, 109 of the 837 retrieved LN (13.1%) were LNM, in 51 patients. These ‘missed’ extraregional LNM were identified in 8 patients, with the remaining LNM identified at regional LN stations in 43 patients. EUS related complications occurred in 3 procedures (1%): bleeding requiring embolization in one patient (AGREE III) and temporary hypotension in two (AGREE I).

Conclusion

EUS with systematic evaluation of regional and extraregional LN is safe and should be offered to all presumed resectable iCCA and pCCA patients. It provides information for clinical decision making in 20% of patients including identifying malignant extraregional LN precluding resection.

Disclosure

WJL received consultancy fees from Mediglobe. AI received speakers fee from Fujifilm, Micro-Tech, and Olympus. JEvH reports lecture fee from Cook Medical, Fuji Film, Olympus, Boston scientific and Falk. LMGM is a consultant for Boston Scientific. JWP performed as a consultant for Boston Scientific and Pentax Medical. RLJvW performed as a consultant for Boston Scientific and Cook Medical, received speakers fee from Olympus. RPV reports research grants from Boston Scientific, Cook Medical, Prion Medical, consultancy fee from Boston Scientific and Cook Medical, and speakers fee from Mediglobe. PH is a consultant and/or speaker for Boston Scientific, FujiFilm, MedWork and Viatris. MJB reports research grants from Boston Scientific, Cook Medical, Pentax Medical, InterScope, and Mylan, and performed as a consultant for Boston Scientific, Cook Medical, and Pentax Medical. The remaining authors declare that they have no conflicts of interest.

Event

UEG Week Barcelona 2026

Topics

Pancreas Radiology & Imaging Hepatobiliary Endoscopy

Submission format

Abstract

Session

Biliary clinical care: New frontiers in biliary endoscopy

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Endoscopy

Session

Quality in endoscopic practice

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

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Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Mechanisms & Personalised Medicine IBD

Session

Dilemmas in ulcerative colitis: Back to the basics or fast forward

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Yuichi Mori

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UEG Online Course

accredited

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Impact of Polyp Detection in Colonoscopy

Raf Bisschops, Manuele Furnari, Veronique Van der Voort, Pieter Sinonquel

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Overview

This interactive course explores why optimising polyp detection is central to high-quality colonoscopy and its direct impact on morbidity and mortality. Designed for general gastroenterologists and young endoscopists, the course addresses key quality indicators, bowel preparation, scoping techniques, and the integration of AI for improved detection. Participants will learn to interpret and apply optical diagnosis systems (NICE, WASP, LST-classification, BLINC) and to choose appropriate therapeutic strategies tailored to polyp type and patient context. Surveillance intervals and outcome factors, including family history and syndromes, will be discussed in line with ESGE guidelines. Case-based discussions will focus on communication with patients regarding diagnosis and management. By combining expert testimony, videos, and practical strategies, the course aims to improve participants’ endoscopic practice, ensuring earlier detection, appropriate treatment, and better long-term outcomes.

Target Audience:

Gastroenterologists (in training)
Other physicians and surgeons
Nurses
Medical students

Event

Impact of Polyp Detection in Colonoscopy

Topics

Endoscopy Colorectal

Accreditation status

accredited

Duration

1 hour

Published

2025

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