|
|
Back to 2018 Posters
CT IS BETTER THAN SMALL BOWEL ENDOSCOPY AS A DIAGNOSTIC TOOL LEADING TO SURGERY IN PATIENTS WITH SMALL BOWEL TUMORS - RETROSPECTIVE EVALUATION IN TERTIARY REFERRAL CENTRE.
Anna Pietrzak*2,1, Piotr Surowski1, Adam Dmitruk1, Paulina Wieszczy2, Tomasz Olesinski1
1Gastroenterology, Institute of Oncology, Warsaw, Poland; 2Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
Small bowel (SB) tumors are relatively rare and heterogeneous with no clearly defined diagnostic guidelines; thus its diagnosis may be troublesome. Despite many studies concerning accuracy of diagnostic methods used in SB diseases the data about their usefulness in everyday clinical practice for therapeutic decision making, is lacking.
We conducted retrospective observational study characterising patients operated due to SB tumors in tertiary referral centre during 10 years period. The aim of our study was to establish the diagnostic method directly determining surgery and to compare it with others methods in terms of time from the symptoms onset to surgery, number and types of performed exams and patient's general condition. We assessed symptoms leading to begin diagnostics, diagnostic methods used: faecal occult blood test, ultrasonography (USG), small bowel follow-trough (SBFT), computed tomography (CT), scintigraphy, gastroscopy, colonoscopy, endosonography, capsule endoscopy (CE) and double balloon enteroscopy (DBE).
41 patients, who had CT evaluation, met all inclusion criteria for further analysis. Median age was 63 years (23-86), 20 patients (48.8%) were males. The most frequent indication was GI bleeding (22/41), 37/41 tumours were malignant. In 20 patients (48.8%) the decisive diagnostic test was CT (CT group). We compared CT group with patients operated as a result of different diagnostic examination in whom primary CT was nonconclusive - normal or suspected pathology was not clear (non-CT group). Non-CT group patients (n=21) were younger than CT group (59 vs 65.5; p=0.009). There were no differences between sexes, indications for diagnostics, haemoglobin range, operation mode (planned or urgent). Although, we found no difference between two groups in median total diagnostic time (67 days [0-2190] for both groups), we found that patients from non-CT group had statistically more studies (5 vs 3) such as USG (71 vs 40%), SBFTs (47.6 vs 15%), CEs (42.9 vs 5%), and DBEs (28.6 vs 0%). Postoperative course was similar in both groups.
Conclusions: After initial evaluation (when there is a suspicion, that patients' symptoms are caused by SB tumor) CT should be the first diagnostic method. In case CT is negative it should be re-evaluated or repeated (preferably using enteroclysis) before other methods are introduced. There is also no need to confirm SB tumor revealed in CT using other methods, because it has no impact on further management. Applying above recommendations to use almost solely, even repeated, simple imaging studies instead of repeating endoscopy or performing expensive sophisticated methods in everyday clinical practice can lead to better use of financial resources.
Back to 2018 Posters
|
