S3080 The Diagnostic Gap: Rising Small Bowel Cancer Mortality and the Case for Earlier Capsule Endoscopy Use

Introduction: Small bowel cancer (SBC) is a rare gastrointestinal malignancy comprising only 0.6% of new cancer cases in the United States (US) that has historically been diagnosed late, resulting in poor prognosis, as the small bowel is a vast organ with a highly proliferative epithelium. Recent trends indicate rising mortality rates in the United States, potentially due to diagnostic delays, due to the nonspecific nature of presenting symptoms, despite advances in imaging technology such as capsule endoscopy. Methods: We evaluated temporal trends in small bowel cancer mortality across the US and explored the diagnostic gap that could be addressed by earlier use of capsule endoscopy. This retrospective, population-based study used publicly available mortality data from the CDC WONDER database, stratified by sex and US Census regions. Trends in age-adjusted death rates per 100,000 individuals from 1999 to 2023 were analyzed, focusing on cases coded under International Classification of Diseases-10: C17. Analysis focused on diagnosis and management patterns of small bowel cancer, particularly focusing on delayed detection and the underuse of capsule endoscopy. Annual age-adjusted mortality rates of small bowel cancer across demographic groups and geographic regions, and statistical trend analysis were used to assess changes in mortality over time and evaluate disparities by sex and location. Results: From 1999 to 2023, small bowel cancer mortality increased across nearly all US Census regions in an AAMR from 0.5 to 0.7, with the highest age-adjusted death rates observed from 1999 to 2023 in the South (overall AAMR: 0.5). From 1999 to 2023, men consistently exhibited higher mortality rates than women, with an AAMR of 0.7 in 1999 and 0.8 in 2023 for men and 0.4 in 1999 and 0.5 in 2023 for women. The data demonstrates a diagnostic gap, contributing to an increase in mortality. Despite being less invasive and more accessible, capsule endoscopy remains underutilized in early diagnostic pathways for small bowel cancer. Conclusion: This analysis highlights an alarming rise in small bowel cancer mortality and suggests a potential role for earlier capsule endoscopy use in bridging the diagnostic gap. Enhanced clinical awareness and guideline revisions are warranted to promote the timely evaluation of unexplained gastrointestinal symptoms and to establish a new diagnostic and therapeutic algorithm using balloon-assisted endoscopy and capsule endoscopy, potentially improving survival outcomes in this rare but deadly cancer.