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Revista Espanola de Enfermedades... May 2022An 83-year-old female with history of silicosis was referred for upper endoscopy due to duodenal wall thickness detected in thoracic computer tomography (CT). Upper...
An 83-year-old female with history of silicosis was referred for upper endoscopy due to duodenal wall thickness detected in thoracic computer tomography (CT). Upper endoscopy revealed multiple small (1 to 5 mm), whitish polypoid lesions, involving a discrete portion of the descending part of the duodenum with 3 cm extension.
Topics: Aged, 80 and over; Duodenal Neoplasms; Duodenum; Female; Humans; Lymphoma, Follicular
PubMed: 34470459
DOI: 10.17235/reed.2021.8233/2021 -
BMC Surgery Nov 2019Duodenal fibrolipoma and duodenum-jejunum intussusception are both rare occasions in clinical practice. The diagnosis of duodenal fibrolipoma mainly depends on endoscopy...
BACKGROUND
Duodenal fibrolipoma and duodenum-jejunum intussusception are both rare occasions in clinical practice. The diagnosis of duodenal fibrolipoma mainly depends on endoscopy examination, supplemented by CT and MRI. As the tumor grows, some severe symptoms need surgical intervention. As the development of endoscopic techniques, the operation plan should be made individually.
CASE PRESENTATION
A 47-year-old female with the complaint of upper abdominal pain and melena was reported. Abdominal examination revealed upper abdomen lightly tender and blood test showed severe anemia. Image and endoscopy examination exhibited "a giant mass" in the descending (D2) part of duodenum, dragged by the tumor into the distal intestinal canal and causing intussusception. Intermittent blood transfusion treatment, enteral and parenteral nutrition were adopted to adjust her general state. Two weeks later, the mass was resected together with the basement intestinal wall via the jejunum incision and then the intussuscepted D2 part was restored. The paraffin pathological diagnosis correlated with the preoperative judgment of fibrolipoma and the patient was discharged healthy on POD 14.
CONCLUSIONS
Duodenal fibrolipoma is a rare disease, infrequently causing intussusception and severe upper GIB. Duodenoscopy and endoscopic ultrasound contribute to making an appropriate diagnosis, and for patients with severe symptoms needed surgical intervention, operation plan should be individualized depending on the size and location of the lesion.
Topics: Duodenal Diseases; Duodenal Neoplasms; Duodenoscopy; Endosonography; Female; Gastrointestinal Hemorrhage; Humans; Intussusception; Jejunal Diseases; Laparoscopy; Lipoma; Middle Aged; Tomography, X-Ray Computed
PubMed: 31718616
DOI: 10.1186/s12893-019-0634-1 -
Revista Espanola de Enfermedades... May 2022Endoscopic treatment for duodenal neuroendocrine tumors (d-NET) is technically challenging due to the anatomical characteristics of the duodenum, and is associated with...
Endoscopic treatment for duodenal neuroendocrine tumors (d-NET) is technically challenging due to the anatomical characteristics of the duodenum, and is associated with a high risk of perforation and a positive vertical margin because of infiltration into the submucosa. We herein present a case of d-NET that was successfully removed by over-the-scope clip (OTSC)-assisted endoscopic resection. OTSC-assisted endoscopic resection is a safe and reliable treatment method that enables deep submucosal resection in a short time without the risk of perforation.
Topics: Duodenal Neoplasms; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Neoplasms; Middle Aged; Neuroendocrine Tumors; Pancreatic Neoplasms; Stomach Neoplasms
PubMed: 34470453
DOI: 10.17235/reed.2021.8232/2021 -
Medicine May 2020Endoscopic treatment of duodenal papillary tumors is well described. This study aims to provide new evidence for the treatment of benign papillary tumors through...
Endoscopic treatment of duodenal papillary tumors is well described. This study aims to provide new evidence for the treatment of benign papillary tumors through comparisons between endoscopic snare papillectomy (ESP) and endoscopic mucosal resection (EMR).Between May 2010 and December 2017, 72 patients were enrolled. Diagnosis and treatment procedures were ESP and EMR. Endoscopic follow-up evaluation was done periodically as a surveillance measurement for recurrence.Seventy-two patients with ampullary tumors were enrolled, of which 66 had adenomas including 9 high-grade intraepithelial neoplasias and 2 carcinomas in adenoma. Complete resections with tumor-free lateral and basal margins were achieved in all patients. Postoperative complications were bleeding (9.5% in EMR vs 10% in ESP) and pancreatitis (2.4% in EMR and 3.3% in ESP), with no occurrence of perforation, cholangitis or papillary stenosis. Adenoma recurrence was found in 7 patients (14.3% in EMR vs 3.3% in ESP) at 1 year.The ESP procedure is safe and effective for benign ampullary adenoma, high-grade intraepithelial neoplasias, and noninvasive cancer without intraductal tumor growth, which has a shorter procedural duration, as well as lower complication, recurrence rates and hospitalization costs.
Topics: Adenoma; Adult; Aged; Aged, 80 and over; Carcinoma; Duodenal Neoplasms; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Hospitalization; Humans; Male; Middle Aged; Neoplasm Grading; Operative Time; Postoperative Complications; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 32481436
DOI: 10.1097/MD.0000000000020414 -
Four Neuroendocrine Tumor Types and Neuroendocrine Carcinoma of the Duodenum: Analysis of 203 Cases.Neuroendocrinology 2017Several types of neuroendocrine neoplasms (NENs) have been described in the duodenal tract, from low-grade tumors (NETs) to high-grade neuroendocrine carcinomas (NECs)....
BACKGROUND
Several types of neuroendocrine neoplasms (NENs) have been described in the duodenal tract, from low-grade tumors (NETs) to high-grade neuroendocrine carcinomas (NECs). A comprehensive analysis of histology, hormonal profile and prognostic parameters of a sufficiently large duodenal NEN series to cover all main kinds of neoplasms is however lacking.
METHODS
We collected a retrospective series of 203 duodenal wall and ampullary region NENs, from six specialized endocrine pathology centers. All were characterized histopathologically and histochemically, and 190 were followed for a median of 9 years.
RESULTS
Twenty-seven poorly differentiated NECs, mostly from the ampullary region, were identified and shown to lead to patient demise in a median of 10 months. Among 176 NETs, four subtypes were characterized, including 20 gastrinomas, 37 ampullary-type somatostatin-producing NETs (ASTs), 12 gangliocytic paragangliomas (GPs) and 106 nonfunctioning NETs (nfNETs). ASTs and GPs were mostly localized in the ampullary/periampullary region, while gastrinomas and nfNETs were mainly from the proximal duodenum. ASTs and gastrinomas showed high rates of local infiltration (especially lymphoinvasion and deep duodenal wall/pancreatic tissue invasion) and lymph node metastasis, while nfNETs had significantly lower and more size-dependent local invasive potential. Disease-specific survival differed significantly between NETs and NECs, though not among NET subtypes. NET cases with distant metastases (n = 23) were significantly associated with larger size, higher proliferative grade, lymphovascular invasion, deep invasion and local lymph node metastasis.
CONCLUSION
Our careful analysis of a large series of duodenal NENs identified five histologically and prognostically different histotypes of potential clinical relevance.
Topics: Aged; Carcinoma, Neuroendocrine; Duodenal Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Grading; Neuroendocrine Tumors; Retrospective Studies; Survival Analysis
PubMed: 26910321
DOI: 10.1159/000444803 -
Revista Espanola de Enfermedades... May 2022A 53-year-old man presented to our hospital for resection of a duodenal mass because of the increasing diameter. Esophagogastroduodenoscopy revealed a giant oval mass in...
A 53-year-old man presented to our hospital for resection of a duodenal mass because of the increasing diameter. Esophagogastroduodenoscopy revealed a giant oval mass in the back wall of duodenal bulb, which was protruded to the second part of duodenum(Figure 1). Endoscopic ultrasonography (EUS) revealed a submucosal mass with heterogeneous echogenicity and regular shape(Figure 2). Eventually, the patient received endoscopic submucosal dissection (ESD) after signing informed consent. The mass was resected completely and measured 6.0×4.2×3.0 cm [Figure 3]. Histopathological examination revealed a brunner's gland adenoma. There was no complication besides minor intraoperative bleeding. Both surgery and endoscopic resection (ER) are alternative treatments for duodenal adenoma, but the best way remains controversial. Due to the thin wall, narrow cavity and plentiful vascular network of the duodenal bulb, ER is challenging because of the technical difficulty and probability of perforation and bleeding [1]. Our previous study found that ER is an effective and safe way for treating duodenal adenoma on experienced hands, and ER possesses several advantages over surgical resection for selected patients [2,3]. In the present case, we removed the giant BGA by ESD, as far as we know, this is the largest yet removed by ER.
Topics: Adenoma; Brunner Glands; Duodenal Neoplasms; Duodenum; Endoscopic Mucosal Resection; Humans; Male; Middle Aged
PubMed: 35026952
DOI: 10.17235/reed.2022.8595/2022 -
Medicine Oct 2021Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore,... (Observational Study)
Observational Study
Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA.We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into "no-resection" and "resection" groups based on the initial treatment approach. We investigated the long-term outcome of the "no-resection" group and treatment results of the "resection" group, with particular interest in endoscopic resection.Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31-88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2-60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 ± 2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate.With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could be considered especially for the older adults, poor-prognosis patients, or small lesions.
Topics: Adenomatous Polyps; Adult; Aged; Aged, 80 and over; Disease Progression; Duodenal Neoplasms; Endoscopy; Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 34596158
DOI: 10.1097/MD.0000000000027382 -
International Journal of Surgery... Jun 2017Predictors of recurrence following pancreaticoduodenectomy are well described for ductal periampullary cancers but lack reliability for non-ductal tumors. The purpose of...
BACKGROUND
Predictors of recurrence following pancreaticoduodenectomy are well described for ductal periampullary cancers but lack reliability for non-ductal tumors. The purpose of this study is to analyze the disease-free survival (DFS) and to define the predictors of recurrence following resection for ampullary (AC), bile duct (BDC) and duodenal cancers (DC).
MATERIALS AND METHODS
Clinico-pathological data of patients operated on between 2001 and 2011 were retrospectively reviewed. The effect of lymphatic invasion was specified using the lymph node ratio (LNR) and the number of positive nodes (NPN), with thresholds calculated with the likelihood ratio. Kaplan-Meier disease-free survival (DFS) curves were compared for all covariates by a log-rank test. Multivariate logistic regression analyses were performed to identify predictors of recurrence.
RESULTS
135 patients were identified. Mean follow-up was 49 ± 35 months. Median DFS was not reached for AC and was 36 and 18 months for DC and BDC, respectively. Five-year DFS was 52%, 43% and 32% for AC, DC and BDC, respectively. Predictors of recurrence were T4 tumors, neural invasion and preoperative biliary drainage for DC, ≥3 positive nodes and ≥4% loss of BMI for AC, and T3-T4 tumors for BDC.
CONCLUSION
Loss of BMI ≥4% is a strong predictor of recurrence in AC, and the recurrence risk increases with the total number of lymph nodes invaded (0; 1-3; ≥4). Only T stage influences recurrence for BDC. Considering DC, the adverse effect of preoperative biliary drainage should be validated in randomized series.
Topics: Adult; Aged; Aged, 80 and over; Ampulla of Vater; Common Bile Duct Neoplasms; Disease-Free Survival; Duodenal Neoplasms; Female; Humans; Male; Middle Aged; Pancreaticoduodenectomy; Retrospective Studies
PubMed: 28461144
DOI: 10.1016/j.ijsu.2017.04.051 -
Gut Mar 2004The prevalence of duodenal carcinoma is much higher in familial adenomatous polyposis (FAP) than in the background population, and duodenal adenomatosis is found in most...
BACKGROUND
The prevalence of duodenal carcinoma is much higher in familial adenomatous polyposis (FAP) than in the background population, and duodenal adenomatosis is found in most polyposis patients.
AIMS
To describe the long term natural history of duodenal adenomatosis in FAP and evaluate if cancer prophylactic surveillance of the duodenum is indicated.
METHODS
A prospective five nation study was carried out in the Nordic countries and the Netherlands.
PATIENTS
A total of 368 patients were examined by gastroduodenoscopy at two year intervals during the period 1990-2001.
RESULTS
At the first endoscopy, 238 (65%) patients had duodenal adenomas at a median age of 38 years. Median follow up was 7.6 years. The cumulative incidence of adenomatosis at age 70 years was 90% (95% confidence interval (CI) 79-100%), and of Spigelman stage IV 52% (95% CI 28-76%). The probability of an advanced Spigelman score increased during the study period (p<0.0001) due to an increasing number and size of adenomas. Two patients had asymptomatic duodenal carcinoma at their first endoscopy while four developed carcinoma during the study at a median age of 52 years (range 26-58). The cumulative incidence rate of cancer was 4.5% at age 57 years (95% CI 0.1-8.9%) and the risk was higher in patients with Spigelman stage IV at their first endoscopy than in those with stages 0-III (p<0.01).
CONCLUSIONS
The natural course of duodenal adenomatosis has now been described in detail. The high incidence and increasing severity of duodenal adenomatosis with age justifies prophylactic examination, and a programme is presented for upper gastrointestinal endoscopic surveillance.
Topics: Adenomatous Polyposis Coli; Adolescent; Adult; Aged; Child; Disease Progression; Duodenal Diseases; Duodenal Neoplasms; Female; Follow-Up Studies; Humans; Intestinal Polyposis; Male; Middle Aged; Neoplasm Staging; Population Surveillance; Prospective Studies
PubMed: 14960520
DOI: 10.1136/gut.2003.027771 -
United European Gastroenterology Journal May 2021Adenomatous polyposis (AP) diseases, including familial adenomatous polyposis (FAP), attenuated FAP (AFAP), and MUTYH-associated polyposis (MAP), are the second most... (Review)
Review
Adenomatous polyposis (AP) diseases, including familial adenomatous polyposis (FAP), attenuated FAP (AFAP), and MUTYH-associated polyposis (MAP), are the second most common hereditary causes of colorectal cancer. A frequent extra-colonic manifestation of AP disease is duodenal polyposis, which may lead to duodenal cancer in up to 18% of AP patients. Endoscopic surveillance is recommended at 0.5- to 5-year intervals depending on the extent of polyp growth and histological progression. Although the Spigelman classification is traditionally used to determine surveillance intervals, it lacks information on the (peri-)ampullary site, where 50% of duodenal carcinomas are located. Hence, information on the papilla has recently been added as a prognostic marker. Patients with duodenal adenoma(s) ≥10 mm and ampullary adenomas of any size are suggested to be referred to an expert center for endoscopic therapy, particularly endoscopic mucosal resection and endoscopic ampullectomy. Nonetheless, despite the logic of this approach, the long-term efficacy of endoscopic therapy is still to be demonstrated.
Topics: Adenomatous Polyposis Coli; Duodenal Neoplasms; Duodenoscopy; Endoscopic Mucosal Resection; Humans; Male; Middle Aged; Neoplasm Staging; Patient Compliance; Prognosis; Time Factors
PubMed: 34529357
DOI: 10.1002/ueg2.12071