Tumors of the small intestine are being increasingly recognized and dealt with by the endoscopy community. In part, this is due to improved tools to assess these lesions, and better methods and techniques to treat them.

For instance, the video clip Video 1 shows two different patients with recently discovered dysplastic duodenal lesions. The first is a periampullary tubular adenoma and the second is an antimesenteric tubulovillous adenoma. Both of these lesions were discovered during surveillance endoscopy, both were staged using endoscopic ultrasonography and both were removed using endoscopic techniques.

Endoscopic therapy has been shown to be safe and effective for these lesions ¹.

With the advent of capsule endoscopy and double balloon endoscopy, the number of lesions found and treated will continue to grow ^2,3.

Certain conditions lead to an increase in the development of small bowel tumors. One well defined entity is adenomatous poliposis coli (APC) ⁴. In this issue of VHJOE, we have a review by Dr James Disario of the University of Utah, discussing management techniques of this patient group based on his large experience with patients in the Utah hereditary cancer registry.

For those with interest, an image from the Visible Human data set showing a coronal cross section through the duodenum Figure 1. The data set can be entered by clicking on the indicated target to allow the reader to explore the anatomy of this region.

We hope our readers find the discussion by Dr. Disario interesting, and that this article will improve our readers abilities in providing care to patients with these lesions.

Figure 1: A coronal cross section of the duodenum. Click here to launch Interactive Atlas		Video Clip 1: Images from two different patients Larger Versions: Low Resolution (539 KB) High Resolution (2.6 MB)

1. Apel D, Jakobs R, Spiethoff A, Riemann JF. Follow-up after endoscopic snare resection of duodenal adenomas Endoscopy. 2005 May;37(5):444-8 <Related link>

2. Burke CA, Santisi J, Church J, Levinthal G. The utility of capsule endoscopy small bowel surveillance in patients with polyposis Am J Gastroenterol. 2005 Jul;100(7):1498-502. <Related link>

3. Matsumoto T, Esaki M, Moriyama T, Nakamura S, Iida M. Comparison of capsule endoscopy and enteroscopy with the double-balloon method in patients with obscure bleeding and polyposis. Endoscopy. 2005 Sep;37(9):827-32. <Related link>

4. Attard TM, Cuffari C, Tajouri T, Stoner JA, Eisenberg MT, Yardley JH, Abraham SC, Perry D, Vanderhoof J, Lynch H. Multicenter experience with upper gastrointestinal polyps in pediatric patients with familial adenomatous polyposis.Am J Gastroenterol. 2004 Apr;99(4):681-6. <Related link>