Vascular, polypoid, and other lesions of the small bowel.

Recent developments in enteroscopy have been changing the diagnostic and therapeutic algorithm for diseases of the small bowel. In particular, double-balloon endoscopy has enabled the endoscopic treatment of small-bowel diseases. A majority of vascular lesions can now be treated endoscopically. The presence or absence of arterial components provides important information for selecting endoscopic treatments. In the case of Peutz-Jeghers syndrome, gastrointestinal screening of the small bowel should be started from childhood, and when polyps develop they should be managed by endoscopic resection as opposed to laparotomy. For familial adenomatous polyposis, duodenal and ampullary cancers are major causes of death after prophylactic colectomy. Intensive surveillance and treatment of such patients may lead to reduction of mortality related to duodenal cancer. The prognosis of malignant tumours of the small bowel was previously poor because early diagnosis was impossible. The new technologies have facilitated the diagnosis of these tumours, and improvements in the prognosis can be expected.