Detection of small bowel tumors by videocapsule endoscopy in patients with acromegaly

Growth hormone and gastrointestinal malignancy: An intriguing link

Growth hormone (GH) excess is associated with several systemic complications, one of which is the increased risk of neoplastic processes particularly of the gastrointestinal (GI) tract. Among the GI neoplasms, the most reported association is with benign and malignant neoplasms of the colon. In the majority of published literature, an increased incidence of GI neoplasms, both colonic adenomas as well as colorectal carcinoma is reported. However, the studies on colon cancer-specific mortality rate are conflicting with recent studies reporting similar cancer-specific mortality rates in comparison to controls. Many studies have reported an association of colorectal neoplasms with GH levels. Pathogenic mechanisms put forward to explain this association of GH excess and GI neoplasms primarily involve the increased GH-insulin-like growth factor 1 (IGF-1) signaling. Both GH and IGF-1 have proliferative, anti-apoptotic, and angiogenic effects on the systemic tissues leading to cellular proliferation. Other contributing factors to the increased risk of GI neoplasms include slow intestinal transit with a redundant large bowel, altered bile acids, deranged local immune response, shared genetic susceptibility factors and hyperinsulinemia. In view of the increased risk association, most guidelines for the care of acromegaly patients recommend an initial screening colonoscopy. Recommendations for further follow-up colonoscopy differ but broadly, the guidelines agree that it depends on the findings at first colonoscopy and state of remission of GH excess. Regarding the concern about the risk of colorectal cancers in patients receiving recombinant GH therapy, most cohort studies do not show an increased risk.

Detection of polyps in the small bowel of patients with acromegaly via capsule endoscopy

BACKGROUND

the prevalence of small bowel (SB) polyps is unknown in acromegaly patients.

OBJECTIVE

to evaluate the prevalence of polyps/tumors in SB of acromegaly patients.

MATERIAL

this was a prospective and observational study that compared the prevalence of polyps/tumors using capsule endoscopy with a standard protocol in asymptomatic acromegaly patients and non-acromegaly patients, with abdominal pain, diarrhea or anemia.

RESULTS

one hundred and eighty-three cases were included (61 acromegaly and 122 non-acromegaly). Polyps were found in six (9.8%) and three (2.5%) patients, respectively (RR: 4 [95% CI, 1.03-15.45; p = 0.038]). There were no differences in the tumors (n = 4, 6.6% vs n = 7, 5.7%).

CONCLUSIONS

acromegaly may be associated with more polyps in SB.

Indications for small bowel capsule endoscopy and its safety and diagnostic yield in Mexican patients. Experience at a tertiary care hospital center

INTRODUCTION

Appearing in the year 2000, capsule endoscopy revolutionized the study of the small bowel. It is the gold standard for the study of small bowel bleeding and is considered a safe procedure.

OBJECTIVE

The aim of the present study was to identify the indications for, diagnostic yield, and safety of capsule endoscopy in Mexican patients.

MATERIALS AND METHODS

A descriptive study was conducted on the first 500 small bowel capsule endoscopies performed at a tertiary care hospital center in Mexico City. Sex, age, type of video camera employed, bowel transit time, referral diagnosis, and capsule endoscopy findings and complications were registered.

RESULTS

Mean patient age was 55years (±17.63) and 57.9% of the cases were women. Complete visualization of the small bowel was achieved in 420 capsule endoscopies (84%). Mean bowel transit time was 272.25minutes (±114.86). The most common indications for the procedure were small bowel bleeding (65.2%), search for neoplasia (14.4%), and Crohn's disease (10.2%). The presence of ulcers was the most common finding in small bowel bleeding (24.8%), followed by angioectasias (18.9%). Capsule retention was the only complication and it presented in 11 patients (2.2%).

CONCLUSIONS

Capsule endoscopy is a safe and efficacious method for studying the small bowel. The results obtained in Mexican patients were similar to those described in the international literature. The present case series is the largest reported in a Mexican population.