The role of wireless capsule endoscopy (WCE) in the detection of occult primary neuroendocrine tumors

• Published in: Journal of gastrointestinal and liver diseases : JGLD Vol. 26; no. 2; pp. 151 - 156
• Main Authors: Furnari, Manuele, Buda, Andrea, Delconte, Gabriele, Citterio, Davide, Voiosu, Theodor, Ballardini, Giovanni, Cavallaro, Flaminia, Savarino, Edoardo, Mazzaferro, Vincenzo, Meroni, Emanuele
• Format: Journal Article
• Language: English
• Published: Romania 01.06.2017
• Subjects: Adult; Aged; Bile Duct Neoplasms - diagnosis; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Biopsy; Capsule Endoscopy; Female; Humans; Intestinal Neoplasms - diagnosis; Intestinal Neoplasms - pathology; Intestinal Neoplasms - surgery; Liver Neoplasms - secondary; Male; Middle Aged; Neoplasms, Unknown Primary - diagnosis; Neoplasms, Unknown Primary - pathology; Neoplasms, Unknown Primary - surgery; Neuroendocrine Tumors - diagnosis; Neuroendocrine Tumors - pathology; Neuroendocrine Tumors - surgery; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Unnecessary Procedures
• ISSN: 1841-8724; 1842-1121
• DOI: 10.15403/jgld.2014.1121.262.wce

Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumors in patients showing liver NET metastases when first-line investigations are inconclusive. Twenty-four patients with a histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration. Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded. Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.