| Modality | When to use | Typical presentations prompting workup | Advantages | Limitations / risks | Key guideline or review points | Citations |
|---|---|---|---|---|---|---|
| Small-bowel capsule endoscopy (SBCE/CE) | First-line luminal evaluation when a small-bowel tumor is suspected and there is no evidence of stenosis or prior resection; also recommended in patients at increased risk of small-bowel tumors; preferred first-line method for hereditary-syndrome surveillance programs | Obscure small-bowel bleeding, unexplained iron-deficiency anemia, suspected small-bowel tumor, surveillance in hereditary syndromes such as PJS/FAP/selected LS settings | Noninvasive, outpatient, visualizes entire mucosa, high sensitivity, excellent safety profile; reported diagnostic yield up to 91% in hereditary surveillance settings | Cannot biopsy or treat; may miss solitary proximal/protruding lesions; capsule retention about 1-2%; lesion size/location can be imprecise | ESGE recommends SBCE as an initial diagnostic tool in suspected small-bowel tumors without stenosis; not recommended for follow-up of treated tumors due to insufficient data; in hereditary settings it is commonly the primary surveillance test | (pqac-00000006, pqac-00000008, pqac-00000009, pqac-00000012, pqac-00000027, pqac-00000034) |
| Device-assisted enteroscopy (DAE; DBE/SBE/spiral) | Use when imaging already suggests tumor, when tissue diagnosis is needed after SBCE, when therapeutic intervention is likely, or to confirm subepithelial lesions | Positive SBCE, suspected mass needing biopsy, high polyp burden/polyps needing resection, obstructive symptoms, hereditary syndrome surveillance with actionable lesions | Direct visualization, biopsy, tattooing, endoscopic therapy/polypectomy, route can be guided by prior SBCE | More invasive, time-consuming, requires sedation/deep sedation, lower complete small-bowel examination rate than SBCE | ESGE prefers DAE over capsule if prior imaging has demonstrated tumor suspicion; biopsy is required for uncertain capsule findings; DBE diagnostic yield improves substantially when preceded by positive SBCE | (pqac-00000006, pqac-00000007, pqac-00000009, pqac-00000011, pqac-00000012, pqac-00000027) |
| CT enterography / cross-sectional CT | Complementary test when SBCE may miss protruding lesions or when extraluminal disease, staging, or operability assessment is needed; useful if tumor is suspected on symptoms or endoscopy | Bleeding/IDA with concern for mass, suspected subepithelial lesion, concern for obstruction/stenosis, preoperative staging | Evaluates mural/extramural disease, metastatic spread, operability; complements capsule limitations for masses | Radiation exposure; less sensitive than mucosal endoscopy for subtle superficial lesions; no biopsy | ESGE notes CT enterography can reasonably complement SBCE, particularly when small-bowel tumor is suspected; once diagnostic certainty is high, cross-sectional imaging is recommended for staging and operability assessment | (pqac-00000006, pqac-00000012) |
| MR enterography / MRI-based small-bowel imaging | Alternative or adjunct cross-sectional imaging, especially in surveillance programs and when repeated imaging is anticipated; used with CE in PJS and other hereditary settings | Hereditary syndrome surveillance, suspected mass/polyp burden, need to localize lesions or assess bowel beyond mucosa | No ionizing radiation; complements CE for localization and burden assessment | Less direct mucosal detail than endoscopy; no biopsy or endoscopic therapy | Reviews of hereditary SBC surveillance recommend combined approaches using CE with CT/MR enterography; PJS protocols may alternate CE and MRI-enterography every 1-3 years | (pqac-00000009, pqac-00000031, pqac-00000032) |
| Push enteroscopy / routine upper endoscopy-colonoscopy extensions | Targeted use for proximal duodenal/jejunal lesions, especially in FAP/LS where proximal lesions may be reachable by standard upper endoscopy or push techniques | Duodenal polyposis, proximal small-bowel lesions, hereditary syndromes with duodenal risk | Allows direct inspection/biopsy of reachable proximal lesions; integrates with routine surveillance | Limited reach beyond proximal small bowel | In FAP, push enteroscopy is recommended for advanced Spigelman stage disease; in LS, duodenal/distal ileal lesions may be accessible with routine gastroscopy/colonoscopy, so routine jejunoileal screening is generally not recommended except selected high-risk groups | (pqac-00000028) |
| Multimodal workup pathway | Best when suspicion remains despite a single negative test or when hereditary risk is present | Persistent obscure bleeding/IDA, positive occult blood with high-risk cancer history, nonresponsive/complicated celiac disease, hereditary syndrome surveillance | Improves detection, localization, histologic confirmation, and treatment planning | Requires coordination and resource availability | Reviews emphasize combining endoscopy, cross-sectional imaging, and genetic risk stratification in tertiary centers; AI-assisted CE/enterography may improve workflow in the future | (pqac-00000010, pqac-00000027, pqac-00000034) |


*Table: This table summarizes the main diagnostic modalities used for suspected small-bowel tumors, including when each test is typically used, its strengths and limitations, and recent guideline-based recommendations. It is useful for comparing first-line luminal evaluation with confirmatory, therapeutic, and staging approaches.*