UMMS Affiliation

Department of Medicine, Division of Gastroenterology; Department of Surgery; School of Medicine; Senior Scholars Program

Faculty Mentor

David Cave

Publication Date


Document Type



Diagnosis | Digestive System Diseases | Gastroenterology | Medical Education | Neoplasms | Pathology | Surgical Procedures, Operative


The diagnosis of small-bowel tumors is challenging due to their low incidence, nonspecific presentation, and limitations of traditional endoscopic techniques. In our study, we examined the utility of the mucosal protrusion angle in differentiating between true submucosal masses and bulges of the small bowel on video capsule endoscopy. We retrospectively reviewed video capsule endoscopies of 34 patients who had suspected small-bowel lesions between 2002 and 2017. Mucosal protrusion angles were defined as the angle between the small-bowel protruding lesion and surrounding mucosa and were measured using a protractor placed on a computer screen. We found that 25 patients were found to have true submucosal masses based on pathology and 9 patients had innocent bulges due to extrinsic compression. True submucosal masses had an average measured protrusion angle of 45.7 degrees +/- 20.8 whereas innocent bulges had an average protrusion angle of 108.6 degrees +/- 16.3 (p < 0.0001; unpaired t-test). Acute angle of protrusion accurately discriminated between true submucosal masses and extrinsic compression bulges on Fisher's exact test (p = 0.0001). Our findings suggest that mucosal protrusion angle is a simple and useful tool for differentiating between true masses and innocent bulges of the small bowel.


small-bowel bulge, small-bowel mass, video capsule endoscopy

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Copyright © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (

DOI of Published Version



J Clin Med. 2019 Mar 27;8(4). pii: jcm8040418. doi: 10.3390/jcm8040418. Link to article on publisher's site

Journal/Book/Conference Title

Journal of clinical medicine


Michael Noujaim participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School

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Link to Article in PubMed

PubMed ID


Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.