Small bowel tumors are uncommon lesions that are infrequently suspected. We analyzed the clinical presentation, traditional and new diagnostic tools, surgical treatment, and survival in our experience. This was a retrospective review of 45 patients with small bowel neoplasm over a 20-year period. Preoperative diagnosis was made only in 17 cases (38%). One lesion was shown using a new diagnostic system: wireless capsule endoscopy (WCE). All patients underwent surgery. Mean 5-year overall survival for malignancies was 23%. Female sex and localized disease were positive prognostic factors for survival. Small bowel neoplasms must be considered in differential diagnosis in patients with abdominal symptoms, weight loss, and intestinal bleeding. Because the preoperative diagnosis rarely is made with traditional diagnostic tools, patients are seen late in the course of the disease, and the prognosis is poor. WCE is useful for identifying lesions earlier than by other diagnostic procedures.