Clinical Endoscopy

Original Article

Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy: Kazuya Inoki, Seiichiro Abe, Yusaku Tanaka, Koji Yamamoto, Daisuke Hihara, Ryoji Ichijima, Yukihiro Nakatani, HsinYu Chen, Hiroyuki Takamaru, Masau Sekiguchi, Masayoshi Yamada, Taku Sakamoto, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda, Takahisa Matsuda, Yutaka Saito; Clin Endosc 2021;54(3):363-370. Published online September 8, 2020; DOI: https://doi.org/10.5946/ce.2020.058

Background
/Aims: Probe-based confocal laser endomicroscopy (pCLE) requires the administration of intravenous (IV) fluorescein. This study aimed to determine the optimal dose of IV fluorescein for both upper and lower gastrointestinal (GI) tract pCLE.
Methods
Patients 20 to 79 years old with gastric high-grade dysplasia (HGD) or colorectal neoplasms (CRNs) were enrolled in the study. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination of the optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by three endoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were not deemed to be visible. If all three endoscopists determined that the tissue structure was visible, the doses were de-escalated.
Results
A total of 12 patients with gastric HGD and 12 patients with CRNs were enrolled in the study. Doses were de-escalated to 0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLE with IV fluorescein at 0.5 mg/kg.
Conclusions
In the present study, pCLE with IV fluorescein 0.5 mg/kg was adequate to visualize the magnified structure of both the upper and lower GI tract.

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Prospective assessment of probe‐based confocal laser endomicroscopy under direct cholangioscopic visualization for biliary strictures that could not be definitively diagnosed using endoscopic retrograde cholangiopancreatography (with video)
Yuki Tanisaka, Shomei Ryozawa, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Ryuichi Watanabe, Ryo Sato, Tomoaki Tashima, Yumi Mashimo
DEN Open.2025;[Epub] CrossRef
Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy
Francesco Vito Mandarino, Silvio Danese, Toshio Uraoka, Adolfo Parra‐Blanco, Yasuharu Maeda, Yutaka Saito, Shin‐Ei Kudo, Michael J. Bourke, Marietta Iacucci
Digestive Endoscopy.2024; 36(7): 761. CrossRef

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Case Reports

A Case of a Bleeding Duodenal Lipoma Successfully Controlled by Endoscopic Resection: Seo Yeon Gwak, Mi Kyung Lee, Yong Kang Lee; Clin Endosc 2020;53(2):236-240. Published online July 24, 2019; DOI: https://doi.org/10.5946/ce.2019.035

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This is a case report of successful endoscopic resection (ER) of a bleeding duodenal lipoma. An 85-year-old woman who was diagnosed with asymptomatic subepithelial tumor of the duodenum 3 years ago visited the emergency room with hematemesis and was admitted to our hospital. Emergent esophagogastroduodenoscopy revealed bleeding from an ulcer on the superior aspect of a subepithelial tumor measuring about 20 mm in diameter, at the superior duodenal angle. The ulcer was in the active stage (A1), with a visible vessel. The bleeding was controlled by ER of the tumor using a snare. The final pathological diagnosis was duodenal lipoma with mucosal ulceration. The patient showed no signs of bleeding for 10 days after the procedure; subsequently, she was discharged and followed up for regular checkups.

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Endoscopically resected duodenal lipoma as an uncommon cause of upper gastrointestinal bleeding: a case report
Dong Chan Joo, Gwang Ha Kim, Bong Eun Lee, Moon Won Lee, Cheolung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef

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A Rare Duodenal Subepithelial Tumor: Duodenal Schwannoma: Dong Hwahn Kahng, Gwang Ha Kim, Sang Gyu Park, So Jeong Lee, Do Youn Park; Clin Endosc 2018;51(6):587-590. Published online May 15, 2018; DOI: https://doi.org/10.5946/ce.2018.050

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Schwannomas are uncommon neoplasms that arise from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare among mesenchymal tumors of the gastrointestinal tract, and only a few cases have been reported to date. Duodenal schwannomas are usually discovered incidentally and achieving a preoperative diagnosis is difficult. Schwannomas can be distinguished from other subepithelial tumors on endoscopic ultrasonography; however, any typical endosonographic features of duodenal schwannomas have not been reported due to the rarity of these tumors. Immunohistochemistry is essential to distinguish schwannomas from gastrointestinal stromal tumors and leiomyomas. We report a case of duodenal schwannoma found incidentally during a health check-up endoscopy. On endoscopic ultrasonography, this tumor was suspected as a gastrointestinal stromal tumor; therefore, the patient underwent laparoscopic wedge resection of the tumor. Histopathology and immunohistochemistry confirmed that the duodenal lesion was a benign schwannoma.

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Ileal Schwannoma: A Rare Cause of Pelvic Mass
Martin Jezovit, Hasan Bakirli, Ifrat Bakirov, Khalid Hureibi, Gultakin Bakirova, Roman Okolicany, Pavol Janac, Iveta Meciarova, Nasser Alhwaymel, Ilkin Bakirli, Augustin Prochotsky, Muthukumaran Rangarajan
Case Reports in Surgery.2024;[Epub] CrossRef
Surgical approaches for subepithelial tumors in difficult locations of the gastrointestinal tract
Hoseok Seo
Foregut Surgery.2024; 4(2): 51. CrossRef
Periampullary duodenal schwannoma mimicking ampullary neoplasm
Marly Pierina Rubio Sierra, Aydamir Alrakawi, Ahmad Alduaij, Dana AlNuaimi, Numan Cem Balci
Radiology Case Reports.2020; 15(11): 2085. CrossRef

6,186 View
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Megaduodenum with Duodenal Diospyrobezoars: Hyun Woo Park, Hyun Seok Lee; Clin Endosc 2015;48(5):436-439. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.436

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Bezoars are retained masses of ingested materials accumulating within the gastrointestinal track. While gastric bezoars are often observed, duodenal bezoars are rarely reported. A 77-year-old man who had frequently consumed persimmons and had never undergone gastric surgery had symptoms of epigastric pain and early satiety for 10 days. Esophagogastroduodenoscopy showed many diospyrobezoars in a severely distended duodenal bulb, otherwise known as megaduodenum. The patient's treatment consisted of repeated endoscopic removal of the bezoars by using a retrieval net.

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Case Report: A Child With Functional Chronic Duodenal Obstruction Caused by Megaduodenum
Zhibo Qu, Biao Zheng, Chuncheng Ju, Jiaxu Liu, Bingyang Liu, Haoran Zhang
Frontiers in Pediatrics.2021;[Epub] CrossRef
A rare case of idiopathic congenital megaduodenum in adult misinterpreted during childhood: case report and literature review
Natally Horvat, Vicente Bohrer Brentano, Emerson Shigueaki Abe, Rodrigo Blanco Dumarco, Publio Cesar Cavalcante Viana, Marcel Cerqueira Cesar Machado
Radiology Case Reports.2019; 14(7): 858. CrossRef

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Acute Pancreatitis Due to a Duodenal Ulcer: Sung Ik Pyeon, Jong Ho Hwang, Yong Tae Kim, Ban Seok Lee, Sang Ho Lee, Jae Nam Lee, Jae Hoon Cheong, Kong Jin Oh; Clin Endosc 2014;47(6):579-583. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.579

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Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar.

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Emphysematous pancreatitis associated with penetrating duodenal ulcer
Claudio Tana, Mauro Silingardi, Maria Adele Giamberardino, Francesco Cipollone, Tiziana Meschi, Cosima Schiavone
World Journal of Gastroenterology.2017; 23(48): 8666. CrossRef

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Endoscopic Treatment of Duodenal Neuroendocrine Tumors: Sang Ho Kim, Chang Hwan Park, Ho Seok Ki, Chung Hwan Jun, Seon Young Park, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew; Clin Endosc 2013;46(6):656-661. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.656

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Duodenal neuroendocrine tumors (NETs) are rare neoplasms. In this study, the medical records of 14 patients with duodenal NETs diagnosed at Chonnam National University Hospital from July 2001 to August 2011 were reviewed and analyzed retrospectively. Four patients were diagnosed in the first 5 years, and 10 patients were diagnosed in the latter 5 years of the study. Ten of 12 patients (83.3%) who underwent endoscopic biopsy were confirmed to have NET before resection. Endoscopic resection was performed in 12 patients, surgical resection in one patient, and regular follow-up in one patient who refused resection. None of the patients showed recurrence or distant metastasis. Duodenal NETs are increasingly observed and are mostly detected during screening upper gastrointestinal endoscopy. Careful endoscopic examination and biopsy can improve the diagnostic yield of NETs. Most well-differentiated, nonfunctional duodenal NETs that are limited to the mucosa/submucosa can be treated effectively with endoscopic resection.

Citations

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Endoscopic management of gastric, duodenal and rectal NETs: Position paper from the Italian Association for Neuroendocrine Tumors (Itanet), Italian Society of Gastroenterology (SIGE), Italian Society of Digestive Endoscopy (SIED)
Francesco Panzuto, Maria Caterina Parodi, Gianluca Esposito, Sara Massironi, Alberto Fantin, Renato Cannizzaro, Massimo Milione, Claudio Giovanni De Angelis, Bruno Annibale
Digestive and Liver Disease.2024; 56(4): 589. CrossRef
Conventional endoscopic mucosal resection versus modified endoscopic mucosal resection for duodenal neuroendocrine tumor
Jin Hee Noh, Do Hoon Kim, Kwangbeom Park, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
Surgical Endoscopy.2023; 37(5): 3884. CrossRef
The meaning of R1 resection after endoscopic removal of gastric, duodenal and rectal neuroendocrine tumors
Gianluca Esposito, Elisabetta Dell’Unto, Irene Ligato, Matteo Marasco, Francesco Panzuto
Expert Review of Gastroenterology & Hepatology.2023; 17(8): 785. CrossRef
Duodenal neuroendocrine tumors: Short-term outcomes of endoscopic submucosal dissection performed in the Western setting
Sunil Gupta, Puja Kumar, Rocio Chacchi, Alberto Murino, Edward J Despott, Arnaud Lemmers, Mathieu Pioche, Michael J. Bourke
Endoscopy International Open.2023; 11(11): E1099. CrossRef
Management of Duodenal Neuroendocrine Tumors: Surgical versus Endoscopic Mucosal Resection
Catherine G. Tran, Scott K. Sherman, Mohammed O. Suraju, Apoorve Nayyar, Henning Gerke, Rami G. El Abiad, Chandrikha Chandrasekharan, Po Hien Ear, Thomas M. O’Dorisio, Joseph S. Dillon, Andrew M. Bellizzi, James R. Howe
Annals of Surgical Oncology.2022; 29(1): 75. CrossRef
Endoscopic mucosal resection using a ligation device for duodenal neuroendocrine tumors: a simple method
Yasuhiro Inokuchi, Kei Hayashi, Yoshihiro Kaneta, Yoichiro Okubo, Mamoru Watanabe, Mitsuhiro Furuta, Nozomu Machida, Shin Maeda
Therapeutic Advances in Gastrointestinal Endoscopy.2022;[Epub] CrossRef
Survival and Disease Recurrence in Patients with Duodenal Neuroendocrine Tumours—A Single Centre Cohort
Oddry Folkestad, Hans H. Wasmuth, Patricia Mjønes, Reidun Fougner, Øyvind Hauso, Reidar Fossmark
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Comparison of endoscopic resection techniques for duodenal neuroendocrine tumors: systematic review
Helcio Pedrosa Brito, Isabela Trindade Torres, Karine Corcione Turke, Artur Adolfo Parada, Jaques Waisberg, Ricardo Vieira Botelho
Endoscopy International Open.2021; 09(08): E1214. CrossRef
The Role of Endoscopy in Small Bowel Neuroendocrine Tumors
Ji Yoon Yoon, Nikhil A. Kumta, Michelle Kang Kim
Clinical Endoscopy.2021; 54(6): 818. CrossRef
Systematic review: management of localised low‐grade upper gastrointestinal neuroendocrine tumours
Klaire Exarchou, Nathan Howes, David Mark Pritchard
Alimentary Pharmacology & Therapeutics.2020; 51(12): 1247. CrossRef
Duodenal Neuroendocrine Tumour Resection with a New Duodenal Full-Thickness Resection Device
João Cortez-Pinto, Susana Mão de Ferro, Joana Castela, Isabel Claro, Paula Chaves, António Dias Pereira
GE - Portuguese Journal of Gastroenterology.2020; 27(4): 290. CrossRef
Endoscopic Resection of Duodenal Carcinoid Tumors
Nadim Mahmud, Yutaka Tomizawa, Kristen Stashek, Bryson W. Katona, Gregory G. Ginsberg, David C. Metz
Pancreas.2019; 48(1): 60. CrossRef
Neuroendocrine Carcinoma of Duodenum—an Uncommon Tumour at an Unusual Site
Palki Dewan, Shubha P. Bhat, H. L. Kishan Prasad, Rajesh Ballal, K. Sajitha
Indian Journal of Surgical Oncology.2019; 10(1): 199. CrossRef
Non-functional duodenal neuroendocrine carcinoma: a rare cause of diabetes mellitus
Chad Bisambar, Andrew Collier, Fraser Duthie, Carron Meney
Endocrinology, Diabetes & Metabolism Case Reports.2018;[Epub] CrossRef

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Duodenal Mucosa-Associated Lymphoid Tissue Lymphomas: Two Cases and the Evaluation of Endoscopic Ultrasonography: Su Jin Kim, Hyung Wook Kim, Choel Woong Choi, Jong Kun Ha, Young Mi Hong, Jin Hyun Park, Soo Bum Park, Dae Hwan Kang; Clin Endosc 2013;46(5):563-567. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.563

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Mucosa-associated lymphoid tissue lymphoma mainly arises in the stomach, with fewer than 30% arising in the small intestine. We describe here two cases of primary duodenal mucosa-associated lymphoid tissue lymphoma which were evaluated by endoscopic ultrasonography. A 52-year-old man underwent endoscopy due to abdominal pain, which demonstrated a depressed lesion on duodenal bulb. Endoscopic ultrasonographic finding was hypoechoic lesion invading the submucosa. The other case was a previously healthy 51-year-old man. Endoscopy showed a whitish granular lesion on duodenum third portion. Endoscopic ultrasonography image was similar to the first case, whereas abdominal computed tomography revealed enlargement of multiple lymph nodes. The first case was treated with eradication of Helicobacter pylori, after which the mucosal change and endoscopic ultrasound finding were normalized in 7 months. The second case was treated with cyclophosphamide, vincristine, prednisolone, and rituximab every 3 weeks. After 6 courses of chemotherapy, the patient achieved complete remission.

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Primary Gastric and Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma With Symptomatic Anemia
Abdulla Alabed, Faisal Abubaker, Omar Sharif, Alddana Zayed, Eman Aljufairi
ACG Case Reports Journal.2024; 11(7): e01438. CrossRef
Review of lymphoma in the duodenum: An update of diagnosis and management
Masaya Iwamuro, Takehiro Tanaka, Hiroyuki Okada
World Journal of Gastroenterology.2023; 29(12): 1852. CrossRef
Synchronous duodenal mucosa-associated lymphoid tissue lymphoma and gastric cancer
Keiichiro Yokota, Tsutomu Namikawa, Masahiro Maeda, Nobuhisa Tanioka, Jun Iwabu, Sunao Uemura, Masaya Munekage, Hiromichi Maeda, Hiroyuki Kitagawa, Michiya Kobayashi, Kazuhiro Hanazaki
Clinical Journal of Gastroenterology.2021; 14(1): 109. CrossRef
Early, Isolated Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma Presenting without Symptoms or Grossly Apparent Endoscopic Lesions and Diagnosed by Random Duodenal Biopsies
Mihajlo Gjeorgjievski, Issa Makki, Pradeep Khanal, Mitual B. Amin, Ann Marie Blenc, Tusar Desai, Mitchell S. Cappell
Case Reports in Gastroenterology.2016; 10(2): 323. CrossRef

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Special Issue Articles of IDEN 2013

Endoscopic Treatments of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations: Tae Hoon Lee, Joung-Ho Han, Sang-Heum Park; Clin Endosc 2013;46(5):522-528. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.522

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Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires prompt diagnosis and surgical management. Perforation can follow various clinical courses, and management depends on the cause of the perforation. Cases resulting from sphincterotomy or guidewire-induced perforation can be managed by conservative treatment and biliary diversion. The current standard treatment for perforation of the duodenal free wall is early surgical repair. However, several reports of primary endoscopic closure techniques using endoclip, endoloop, or newly developed endoscopic devices have recently been described, even for use in direct perforation of the duodenal wall.

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Endoscopic Treatment for Early Foregut Neuroendocrine Tumors: Moo In Park; Clin Endosc 2013;46(5):450-455. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.450

Abstract PDF PubReader ePub

Foregut neuroendocrine tumors (NETs) include those arising in the esophagus, stomach, pancreas, and duodenum and seem to have a broad range of clinical behavior from benign to metastatic. Several factors including the advent of screening endoscopy may be related to increased incidence of gastrointestinal NETs; thus, many foregut NETs are diagnosed at an early stage. Early foregut NETs, such as those of the stomach and duodenum, can be managed with endoscopic treatment because of a low frequency of lymph node and distant metastases. However, controversy continues concerning the optimal management of early foregut NETs due to a lack of controlled prospective studies. Several issues such as indications, technical issues, and outcomes of endoscopic treatment for early foregut NETs are reviewed based on some published studies.

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Kwangwoo Nam, Su Youn Nam, Jun Chul Park, Young Sin Cho, Hyuk Soon Choi, Kyoungwon Jung, Seon-Young Park, Joon Hyun Cho, Hyonho Chun
Digestive and Liver Disease.2024; 56(9): 1592. CrossRef
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Efficacy and safety of 177Lu‑DOTATATE in patients with advanced pancreatic neuroendocrine tumours: data from the NETTER-R international, retrospective study
Dominique Clement, Shaunak Navalkissoor, Rajaventhan Srirajaskanthan, Frédéric Courbon, Lawrence Dierickx, Amy Eccles, Valerie Lewington, Mercedes Mitjavila, Juan Carlos Percovich, Benoît Lequoy, Beilei He, Ilya Folitar, John Ramage
European Journal of Nuclear Medicine and Molecular Imaging.2022; 49(10): 3529. CrossRef
A Case of Asymptomatic Multiple Endocrine Neoplasia Type I with Thymic Carcinoid
Suk Ki Park, Moon Won Lee, In Sub Han, Young Joo Park, Sung Yong Han, Joon Woo Park, Bong Eun Lee, Gwang Ha Kim, Sang Soo Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2019; 19(1): 65. CrossRef
Prognostic role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with midgut neuroendocrine tumors undergoing resective surgery
Anna Pozza, Bruno Pauletti, Marco Scarpa, Cesare Ruffolo, Nicolò Bassi, Marco Massani
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Timothy L. Fitzgerald, Samuel O. Dennis, Swapnil D. Kachare, Nasreen A. Vohra, Emmanuel E. Zervos
Surgery.2015; 158(2): 466. CrossRef
Small cell neuroendocrine carcinoma of the esophagus
Yu‐Ling Huang, Shah‐Hwa Chou, Chee‐Yin Chai, Jui‐Sheng Hsu
The Kaohsiung Journal of Medical Sciences.2015; 31(2): 108. CrossRef

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Case Reports

A Case of Enteritis Cystica Profunda in the Ampulla of Vater Mimicking Choledochocele: Kyoung Wan You, Sang Wook Park, Geum Soo Lee, Du Jin Kim, Hyeung Cheol Moon, Gun Young Hong; Clin Endosc 2013;46(2):178-181. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.178

Abstract PDF PubReader ePub

Enteritis cystica profunda is a very rare disease in which a mucin-filled cystic space is surrounded partially with nonneoplastic columnar epithelium in the submucosa of the small intestine. Most of the cases are accompanied by intestinal diseases, and the disease usually occurs in the jejunum and the ileum and there has been no report of a case that occurred in the ampulla of Vater. A 58-year-old healthy female patient without any particular symptom visited the hospital to get additional examination for a mass found on the ampulla of Vater by accident. In esophagogastroduodenoscopy, a cystic mass showing a positive pillow sign was found on the ampulla of Vater. Endoscopic retrogradecholangiopancreatography was conducted as choledochocele was suspected, but no abnormality was found in the biliary system. In endoscopic ultrasonography, multiseptated cystic structures were detected in the submucosal layer of the duodenum. The lesion was resected completely through endoscopic snare polypectomy and the case was histologically diagnosed as enteritis cystica profunda.

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Bowel Obstruction Due to the Mesenteric Mass Being an Enteritis Cystica Profunda: A Case Report
Meshael S Albahli, Fares Ali M Aljarallah, Ali K Alshaya, Nourah Alabdulaaly, Khaled Altoukhi, Haider A Alshurafa
Cureus.2025;[Epub] CrossRef
Enteritis cystica profunda: Case report and literature review
Ricardo E. Núñez-Rocha, Felipe Girón, Mario Latiff, Carlos Eduardo Rey, Lina Rodríguez, Juan David Hernández
International Journal of Surgery Case Reports.2023; 106: 108148. CrossRef
Enteritis cystica profunda with lipoma in the second portion of the duodenum: a case report
Beom Jin Shim, Seung Keun Park, Hee Ug Park, Tae Young Park
Journal of Yeungnam Medical Science.2022; 39(1): 72. CrossRef
Ulcerated choledochocele: A case report
E. Ray-Offor, S.N. Elenwo, P.O. Igwe, C. Ngeribara
International Journal of Surgery Case Reports.2016; 28: 42. CrossRef
A Case of Enteritis Cystica Profunda Accompanied by a Lipoma in the Duodenal Bulb
Dae Sung Lee, Hae Ryong Jeong, Jin Ok Kim, Hye Jin Tae, Ho Soon Choi, Hye In Ahn, Seung Sam Paik
Korean Journal of Medicine.2014; 86(3): 314. CrossRef

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A Case of Duodenal Duplication Cyst Manifested by Duodenal Polyp: Hyun Seok You, Su Bin Park, Jin Hee Kim, Hyun Jeong Lee, Seong Pil Jang, Gwang Ha Kim, Geun Am Song; Clin Endosc 2012;45(4):425-427. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.425

Abstract PDF PubReader ePub

Duodenal duplication cyst is a rare anomaly, totaling only 4% to 12% of gastrointestinal duplications, and is usually encountered during infancy or in early childhood. Most are commonly located posterior to the first or second portion of the duodenum. Presenting signs and symptoms include vomiting, decreased oral intake, periumbilical tenderness, abdominal distention, obstructive jaundice, acute pancreatitis, and gastrointestinal bleeding. The traditional treatment of a duodenal duplication cyst has been complete surgical resection, but very few cases of endoscopic treatment have been reported in the literature. Here, we report a case of duodenal duplication cyst that was manifested by a duodenal polyp.

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Anatomical Diseases Caused by Congenital Duodenal Abnormalities
Yu Jin Kim, Heung Up Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(4): 256. CrossRef
Isolated Duodenal Duplication Cyst in a Neonate
Riyazhussein Yakoob Hakda, Deepen V. Makwana, Ramendra Shukla, Urvish Parikh, Sudhir B. Chandna
African Journal of Paediatric Surgery.2022; 19(4): 257. CrossRef
Duodenal duplication cyst presenting as bilious vomiting in a neonate
Bakhtawar Dilawar, La-Raib Hamid, Areeba Nadeem Pirzada, Muhammad Arshad
Journal of Pediatric Surgery Case Reports.2020; 61: 101617. CrossRef
54‐cm enteric duplication cyst in a 13‐year‐old female
Mohamed Elghazali Ahmed Basheer Elhasan, Younis A. Sirdab, Imad A. Bakheit
Clinical Case Reports.2018; 6(11): 2099. CrossRef
An isolated intestinal duplication cyst masquerading as a mucinous cystic neoplasm of the pancreas
Evan Weitman, Sameer Al Diffalha, Barbara Centeno, Pamela Hodul
International Journal of Surgery Case Reports.2017; 39: 208. CrossRef
Safety and Efficacy of Endoscopic Therapy for Nonmalignant Duodenal Duplication Cysts
Mihajlo Gjeorgjievski, Palaniappan Manickam, Gehad Ghaith, Mitchell S. Cappell
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Isolated omental duplication cyst with respiratory epithelium & pancreatic glands: Case report & review of literature
Phuoc T. Nguyen, Novae B. Simper, Charles K. Childers
Journal of Pediatric Surgery Case Reports.2016; 11: 17. CrossRef
Duplication Cyst in the Third Part of the Duodenum Presenting with Gastric Outlet Obstruction and Severe Weight Loss
Osama Shaheen, Samer Sara, Mhd Firas Safadi, Bayan Alsaid
Case Reports in Surgery.2015; 2015: 1. CrossRef

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A Case of Peripheral T-cell Lymphoma of the Duodenum and Jejunum: Hsueh Chen Yueh, M.D., Chi Sung Hwang, M.D., Jae Won Choi, M.D., Seung Keun Park, M.D., Hee Ug Park, M.D. and Hye Sook Kim, M.D.^*; Korean J Gastrointest Endosc 2011;43(1):17-20. Published online July 28, 2011

Abstract PDF: Primary T-cell lymphoma of the duodenum is uncommon, and peripheral T-cell lymphoma of the duodenum is extremely rare. Approximately 90% of primary gastrointestinal lymphomas originate from B-cells and fewer than 10% originate from T-cells. A peripheral T-cell lymphoma involved in the small intestine is usually detected by complications such as gastrointestinal bleeding, perforation, or obstruction. A 57-year-old man complained of postprandial discomfort and weight loss of 5 kg for 1 month. An esophagogastroduodenoscopy showed a deep ulcer with blood clots and whitish exudates. We conducted a Whipple's operation because of the high risk of ulcer perforation and difficulty in distinguishing the ulcer from malignancy. The resected tissue was confirmed as a peripheral T-cell lymphoma. We reported a case of peripheral T-cell lymphoma of the duodenum and jejunum that extended to the pancreatic head where a diffuse lesion was found without any complications or specific symptoms. (Korean J Gastrointest Endosc 2011;43:17-20)

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Management of Duodenal Perforations after Endoscopic Retrograde Cholangiopancreatography: Jong-Hyun Kim, M.D., Keon-Young Lee, M.D., Seung-Ik Ahn, M.D., Kee Chun Hong, M.D., Seok Jung, M.D.*, Don Haeng Lee, M.D.*, Yun-Mee Choe, M.D., Sun Keun Choi, M.D., Yoon-Seok Hur, M.D., Sei Joong Kim, M.D., Young Up Cho, M.D., Seok-Hwan Shin, M.D. and Kyu; Korean J Gastrointest Endosc 2011;42(2):83-89. Published online February 28, 2011

Abstract PDF

Background/Aims: Surgery has been the mainstay of treatment for duodenal perforations after the introduction of endoscopic retrograde cholangiopancreatography (ERCP). Yet there have recently been arguments that conservative management with or without endoscopic intervention may be possible and safe.

Methods: For the patients who received ERCP at Inha University Hospital from Jan. 2001 to Dec. 2007, we retrospectively analyzed the clinical manifestations, the treatment and the clinical outcomes of the cases with duodenal perforation. Results: Among the 1708 ERCP cases, duodenal perforation occurred in eleven (0.6%) patients. There were two cases of duodenal perforations (type I), four cases of peri-Vaterian injury (type II), two cases of bile duct perforations (type III) and three cases of retroperitoneal perforations (type IV). Six patients (55%) were treated surgically while the others were managed conservatively. Except for one death (9.1%), ten patients fully recovered. Either residual diseases or fluid collections, as seen on CT, were present in the surgically managed patients. The median time interval between ERCP and surgery was 19 hours (range: 8∼30 hours).

Conclusions: To decide on the management of duodenal perforation after ERCP, the presence of residual disease or the leakage of intraluminal contents should be considered along with the type of the perforation. (Korean J Gastrointest Endosc 2011;42:83-89)

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Simultaneous Melanosis Duodeni and Melanosis Ilei in a Patient Taking Oral Iron: Kyoung Won Lee, M.D., Woo Jin Jeong, M.D., Joung Hwa Lee, M.D., Jong Won Kang, M.D., Kyeong Hee Jang, M.D., Koon Hee Han, M.D., Gil Hyun Kang, M.D.* and Gab Jin Cheon, M.D.; Korean J Gastrointest Endosc 2010;41(5):308-311. Published online November 30, 2010

Abstract PDF: Melanosis means the accumulation of brown or black pigment in an organ. Melanosis can be observed in virtually all parts of the gastrointestinal tract. However, it most frequently affects the colon. It is said that melanosis in small intestine is very rare, and no case has been reported in which melanosis was simultaneously noted in duodenum and ileum without involving the colonic mucosa. Here we report a case of melanosis duodeni and melanosis ilei which were found simultaneously in a 56-year-old female patient with chronic renal failure and heart failure who had been taking oral ferrous sulfate for 3 years. (Korean J Gastrointest Endosc 2010;41:308-311)

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A Case of Duodenal Diverticulitis: Chang Hyeon Seock, M.D., Hae Kyung Kim, M.D., Tae Il Park, M.D., Byung Min John, M.D., Hyeon U Jo, M.D., Jae Seung Kim, M.D., Kee Bum Kim, M.D.* and Byung Soo Na, M.D.*; Korean J Gastrointest Endosc 2010;41(5):294-297. Published online November 30, 2010

Abstract PDF: Duodenal diverticulitis is difficult to diagnose because it can mimic other common diseases such as cholecystitis and perforated ulcer. Recently, we experienced a rare case of duodenal diverticulitis that was initially suspected on abdominal computed tomography as focal pancreatitis. Although duodenal diverticulitis has been increasingly recognizable before surgery, with the advent of multi-detector computed tomography, misdiagnosis remains problematic since duodenal diverticulitis is commonly not considered in the differential diagnosis of acute abdominal pain. We have to consider this rare disease entity because delayed diagnosis might be a cause of substantial morbidity and mortality. (Korean J Gastrointest Endosc 2010;41:294-297)

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Endoscopic Resection of an Adenocarcinoma Arising from a Sporadic Tubulovillous Adenoma of the Duodenum: Hwa Young Seok, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Hyun Phil Shin, M.D., Sung Won Jung, M.D. and Na Eun Jang, M.D.; Korean J Gastrointest Endosc 2010;41(2):108-112. Published online August 30, 2010

Abstract PDF: Duodenal tumors may pose diagnostic difficulties in asymptomatic young patients because the duodenum may be overlooked during routine upper gastrointestinal endoscopy and because duodenal tumors are rare and present non-specific signs and symptoms. Although adenomas are the most common duodenal tumors, adenocarcinoma arising from sporadic tubulovillous adenoma without familial adenomatous polyposis is an uncommon condition in young patients. In patients with sporadic duodenal adenomas, the prevalence of colorectal adenomas is higher than prevalence for the general population. Herein, we report the case of a 27-year male with adenocarcinoma arising from a sporadic tubulovillous adenoma of the duodenum. The tumor was completely resected by endoscopic resection. Synchronous colon adenoma was also detected and treated by endoscopic mucosal resection. (Korean J Gastrointest Endosc 2010;41:108-112)

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A Case of Duodenal Gastrointestinal Stromal Tumor Mimicking a Vascular Neoplasm: Jung Kyung Yang, M.D., Yong Seok Kim, M.D., Hoon Sup Koo, M.D., Kwang Il Kim, M.D., Sun Moon Kim, M.D., Euyi Hyeog Im, M.D., Kyu Chan Huh, M.D. and Sang Eok Lee, M.D.*; Korean J Gastrointest Endosc 2010;41(1):26-30. Published online July 31, 2010

Abstract PDF: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasm of the gastrointestinal tract. They are preferentially located in the stomach and small intestine. However, the duodenum is an unusual location for GIST. Here we present a case of a 67-year-old woman with a GIST of the 3rd portion of duodenum mimicking vascular neoplasm as an obscure acute gastrointestinal bleeding. The upper gastrointestinal endoscopy and colonoscopy failed to find the lesion. Finally, a large protruded lesion with ulcer was found at the 3rd portion of duodenum using a colonoscope through the oral approach. A spurting bleeding was developed during hypertonic saline epinephrine injection for treatment of oozing bleeding at the margin of the ulcer. Abdominal 3D CT-angiography showed a round and hypervascular structure at the posterior wall of duodenum. A wedge resection of the third portion of the duodenum was performed. Microscopic findings revealed GIST. (Korean J Gastrointest Endosc 2010;41:26-30)

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A Case of Primary Duodenal Adenocarcinoma Treated by Endoscopic Mucosal Resection: Kun Hyung Cho, M.D., Jae Young Jang, M.D., Ji-Yun Kim, M.D., HyunJin Park, M.D., Nam Sook Park, M.D., Jeung Eun Park, M.D., Seong Dong Sohn, M.D. and Yun Hwa Kim, M.D.*; Korean J Gastrointest Endosc 2010;40(3):186-189. Published online March 30, 2010

Abstract PDF: Primary nonampullary duodenal adenocarcinoma is an extremely rare disease. In the past, almost all duodenal adenocarcinomas were detected at an advanced stage. Yet recently, an increased number of case reports of early duodenal adenocarcinoma has coincided with the advances in the field of endoscopy, and there has also been an increased number of case reports of duodenal adenocarcinoma treated by endoscopic mucosal resection. We report here on a case of primary nonampullary duodenal adenocarcinoma that was treated by endoscopic mucosal resection, and there has been no recurrence for over 3 years, as assessed by endoscopic examination. (Korean J Gastrointest Endosc 2010;40:186-189)

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Two Cases of Pseudomelanosis Duodeni Associated with Systemic Diseases and Oral Iron Supplementation: Kyoung-Hwan Lee, M.D., Tae Hoon Lee, M.D., Yun Suk Shim, M.D., Jun-Ho Choi, M.D., Il-Kwun Chung, M.D., Sang-Heum Park, M.D., Sun-Joo Kim, M.D. and Mee-Hye Oh, M.D.*; Korean J Gastrointest Endosc 2009;39(6):374-378. Published online December 30, 2009

Abstract PDF: Pseudomelanosis duodeni is a rare benign condition that manifests endoscopically as diffuse, small brownish-black spots in the duodenal mucosa, and the histochemical findings show an accumulation of hemosiderin pigment in the duodenal villi's lamina propria. This condition produces no specific symptoms, and it may be reversible. The cause and natural history of the pigmentation have not been clarified, although it is associated with a variety of systemic illnesses and medications. We describe two cases of pseudomelanosis duodeni and the patients had histories of diabetes mellitus, hypertension, chronic renal insufficiency and specific medications. We also review the relevant medical literature on this rare condition. (Korean J Gastrointest Endosc 2009;39:374-378)

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Intramural Duodenal Hematoma following Endoscopic Epinephrine and Thrombin Injection for Bleeding Duodenal Ulcer in a Geriatric Patient with a History of Anticoagulant Drug Use: Jung Bok Park, M.D., Won Ki Bae, M.D., Hyoung Don Lee, M.D., Jung Hoon Kim, M.D., Nam-Hoon Kim, M.D., Kyung-Ah Kim, M.D., June Sung Lee, M.D. and Young Soo Moon, M.D.; Korean J Gastrointest Endosc 2009;39(4):240-243. Published online October 30, 2009

Abstract PDF: Intramural duodenal hematoma is a rare injury of the duodenum due mainly to blunt abdominal trauma and, less commonly, a hematologic disorder, anticoagulant drug use and post-therapeutic endoscopy. Intramural duodenal hematoma following endoscopic intervention is even rarer. Patients usually present with gradual onset of vomiting and abdominal pain approximately 48 h post-injury. The hematoma usually resolves in 1∼2 weeks with conservative therapy. Surgery is usually reserved for patients with suspected duodenal perforation, bile or pancreatic duct compression and inadequate resolution of the hematoma after 1∼2 weeks of conservative therapy. We describe a patient with a history of anticoagulant drug use who developed intramural duodenal hematoma after endoscopic hemostasis of a bleeding duodenal ulcer. Conservative therapy produced a successful outcome. (Korean J Gastrointest Endosc 2009;39:240-243)

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A Case of Cytomegalovirus-Associated Esophageal and Duodenal Ulcers in a Critically Ill Immunocompetent Patient: Su-Yeon Lee, M.D., You Sun Kim, M.D., Jin-Ho Lee, M.D., Jong Hyeok Park, M.D., Sang-Ryul Lee, M.D., Soo-Hyung Ryu, M.D., Jung Hwan Lee, M.D. and Jeong Seop Moon, M.D.; Korean J Gastrointest Endosc 2009;39(4):217-221. Published online October 30, 2009

Abstract PDF: Cytomegalovirus (CMV) infection usually occurs in immunocompromised individuals such as patients who receive chemotherapy, glucocorticoid therapy, and patients infected with human immunodeficiency virus (HIV). CMV infection can also occur in immunocompetent adults, but active infection is apparently rare. CMV infection can present anywhere in the gastrointestinal tract, most commonly in the colon and rarely in the small intestine. Simultaneous CMV infection in the stomach, small bowel and colon of immunocompetent adults has rarely been reported. We report a case of cytomegalovirus-associated esophageal and duodenal ulcers in an immunocompetent adult where the patient had undergone a neurosurgical operation. (Korean J Gastrointest Endosc 2009;39:217-221)

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A Case of a Duodenal Gastrointestinal Stromal Tumor with a Bleeding Ulcer: Hyuk Jin Kwon, M.D., Hyeon Geun Cho, M.D., Myong Hwan Kim, M.D., Geun Jun Ko, M.D., Jin Ho Jeong, M.D.* and Ji Sun Song, M.D.^†; Korean J Gastrointest Endosc 2009;39(1):42-45. Published online July 30, 2009

Abstract PDF: Duodenal gastrointestinal stromal tumors (GISTs) are relatively rare tumors that commonly present with gastrointestinal bleeding. Evaluation with endoscopic ultrasonography (EUS) is a useful technique for the differential diagnosis of GISTs from other submucosal tumors. A 58-year-old man presented with melena and anemia. An esophago-gastroduodenoscopy showed the presence of a submucosal tumor in the second portion of the duodenum with central ulceration and a flat spot. EUS showed the presence of a suspicious malignant GIST that originated from the proper muscle layer, which was successfully resected. We report a case of a duodenal GIST with a bleeding ulcer. Positive reactivity for CD117 and S-100 was demonstrated by immunohistochemical staining. (Korean J Gastrointest Endosc 2009;39:42-45)

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A Case of Intramural Duodenal Hematoma after the Use of the Endoscopic Epinephrine Injection Method for Duodenal Ulcer Bleeding in a Chronic Renal Failure Patient undergoing Maintenance Hemodialysis: Young Yong Ahn, M.D., Soe Hee Ann, M.D., Jeong Eun Yi, M.D., Wook Hyun Lee, M.D., Yeon Oh Jeong, M.D., Eun Hea Kim, M.D., Hea Jung Sung, M.D. and Sang Bum Kang, M.D.; Korean J Gastrointest Endosc 2009;38(2):94-97. Published online February 27, 2009

Abstract PDF: An intramural duodenal hematoma has been mostly reported as a consequence of trauma. It can also result from a hematological disorder, anticoagulant drug use and a post-therapeutic endoscopic procedure. Common symptoms of patients with an intramural duodenal hematoma are vomiting and abdominal pain. An intramural duodenal hematoma is rarely accompanied with pancreatitis and cholangitis due to intestinal obstruction. A diagnosis is made by esophagogastroduodenoscopy and the use of an abdominal CT scan. An intramural duodenal hematoma is mainly treated with conservative therapy but it may sometimes be treated with a surgical procedure. We report one case of an intramural duodenal hematoma after performing a therapeutic endoscopic procedure in a chronic renal failure patient undergoing maintenance hemodialysis. (Korean J Gastrointest Endosc 2009;38: 94-97)

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A Case of Duodenal Fistula Caused by Intra-abdominal Tuberculous Lymphadenopathy during Anti-tuberculous Medication: Kyong Rok Lee, M.D., Kang Seok Seo, M.D., Jun Ho Cheo, M.D., Sang Cheol Choi, M.D., Kang Kim, M.D., Youn Gun Yim, M.D., Gun Young Hong, M.D. and Sang Wook Park, M.D.; Korean J Gastrointest Endosc 2008;37(6):433-437. Published online December 30, 2008

Abstract PDF: Recently, the proportion of extrapulmonary tuberculosis in patients has increased in Korea. Though intestinal tuberculosis in not infrequent, a duodenal fistula caused by tuberculosis is a rare condition. A 29-year-old man was admitted to the Department of Internal Medicine because of fever and weight loss. The patient was a doctor participating in a resident fellowship. The patient was diagnosed with intra-abdominal tuberculous lymphadenopathy and was given anti-tuberculous medication. One month after the administration of medication, the patient showed symptoms and signs of duodenal obstruction because of marked duodenal wall edema and a deep ulcer on the second portion of the duodenum. A computerized tomogram and duodenography revealed the formation of a fistula at the second portion of the duodenum and the presence of abscess-forming tuberculous lymphadenopathy. The use of continuous anti- tuberculous medication resulted in the improvement of the clinical symptoms, with complete healing of the duodenal fistula and tuberculous lymphadenitis. This case suggests that transient clinical worsening in intra-abdominal tuberculous lymphadenitis may occur during an early period of anti- tuberculous medication. (Korean J Gastrointest Endosc 2008;37:433-437)

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Endoscope-guide Infusion of Sodium Phosphate: A Novel Bowel Cleansing Method, Efficacy and Safety Comparisons with Polyethylene Glycol: Kyu-Jong Kim, M.D., Seun Ja Park, M.D., Eun Kyung Shin, M.D., Jun Young Song, M.D., Do Hyun Kim, M.D., Sung Eun Kim, M.D., Won Moon, M.D. and Moo In Park, M.D.; Korean J Gastrointest Endosc 2008;36(3):138-144. Published online March 30, 2008

Abstract PDF: Background
/Aims: Single full-dose oral sodium phosphate (NaP) on the examination day instead of a conventional divided-dose has been used in some patients to reduce burdens and sleep disturbance caused by bowel movement. However, this treatment may be inconvenient to some patients who are adversely affected by the full dose or its-related symptoms. This study compared the quality of bowel preparation, side effects, and patient's acceptance after a full-dose of NaP into the duodenum under an endoscopic examination and with those from conventional polyethylene glycol (PEG). Methods: A total of 60 admitted patients receiving both endoscopy and colonoscopy each day were divided randomly into two groups and given either PEG 4 L (n=33) or an endoscopic infusion of NaP 90 mL (n=27). Before and after the bowel preparation and 1 day later, the blood pressure, body weight, and serum biochemical parameters were measured. In addition, a detailed questionnaire was used to assess the patient's side effects. The quality of bowel cleansing was assessed by a single endoscopist who was blinded to the type of preparation used. Results: Although changes in the serum biochemical parameters (phosphate: increase, potassium: decrease) were observed in the NaP group, all were normalized after 1 day without side effects. There were significant difference in symptoms after the preparation, such as vomiting, but this was not serious. The suction volume was significantly lower in the NaP group. Conclusions: A duodenal infusion of NaP might be used as a new bowel cleansing method in patients having trouble with other procedures. (Korean J Gastrointest Endosc 2008;36:138-144)

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A Case of Duodenal GIST Accompanied with Neurofibromatosis-1, Presenting with Gastrointestinal Bleeding: Sung O Seo, M.D., Hyo Jung Oh, M.D., Ki Hoon Kim, M.D., Chang Soo Choi, M.D., Geom Seog Seo, M.D., Tae Hyeon Kim, M.D., Ki Jung Yun, M.D.* and Suck Chei Choi, M.D.; Korean J Gastrointest Endosc 2007;35(4):254-257. Published online October 30, 2007

Abstract PDF: Gastrointestinal stroma tumors (GISTs) are CD117- positive primary mesenchymal tumors of the gastrointestinal tract and are noted to have a possible non-random association with neurofibromatosis-1 (NF-1, Von Recklinghausen disease). We report a case of a duodenal GIST presenting with gastrointestinal bleeding in a 74-year-old female, and this condition was accompanied with NF-1. A upper gastrointestinal endoscopy and abdominal computed tomography scan revealed several submucosal tumors in the duodenum, jejunum and ileum. Histological and immunohistochemical studies on the surgical resection specimen revealed gastrointestinal stromal tumors of an uncommitted type. The patient was treated with local excision of the tumors and is now in a favorable state. (Korean J Gastrointest Endosc 2007;35:254-257)

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A Case of Intramural Duodenal Hematoma Complicated with Obstructive Jaundice and Pancreatitis following Endoscopic Hemostasis: Hyung Chul Lee, M.D., Kook Hyun Kim, M.D.*, Youn Sun Park, M.D., Hee Jung Moon, M.D., Tae Nyeun Kim, M.D. and Byung Ik Jang, M.D.; Korean J Gastrointest Endosc 2007;34(6):346-350. Published online June 30, 2007

Abstract PDF: An intramural duodenal hematoma is rarely observed in adults and may occur as an iatrogenic complication after endoscopic treatment for duodenal ulcer bleeding, particularly in patients with bleeding disorders or undergoing anticoagulant therapy. Upper gastrointestinal endoscopy, abdominal CT scan and hypotonic duodenography are used to establish a diagnosis. We report a case of an intramural duodenal hematoma complicated with obstructive jaundice and pancreatitis after endoscopic hemostasis in a patient with a cerebral infarction. A 64-year-old male had duodenal ulcer bleeding, which was treated by a local injection of epinephrine followed by hemoclipping. One to three days after the endoscopic treatment, he complained of abdominal pain and jaundice. The abdominal CT scan revealed acute, edematous pancreatitis and a huge hematoma in the 2nd to 4th portion of the duodenum. The follow-up endoscopy revealed severe stenosis of the duodenal lumen caused by an intramural hematoma. He was treated with conservative management for 18 days. There was gradual improvement in the hematoma that had been complicated by jaundice and pancreatitis.

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A Case of Duodenal Intramural Hematoma and Hemoperitoneum after Therapeutic Endoscopy in a Patient with Chronic Renal Failure: Dong Seon Park, M.D., Woon Geon Shin, M.D., Min Kwan Kim, M.D., Jeang A Lee, M.D., Gyeong Mi Heo, M.D. and Hak Yang Kim, M.D.; Korean J Gastrointest Endosc 2007;34(5):269-273. Published online May 30, 2007

Abstract PDF: Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. It is also less commonly reported as a complication of anticoagulation therapy or as a blood dyscrasia, and as a complication of diagnostic/ therapeutic endoscopy. The presentation of these patients is abdominal pain, vomiting, fever and hematochezia, and this is rarely accompanied with intestinal obstruction, severe pancreatitis and acute peritonitis as its complications. The diagnosis is made clear by performing abdominal ultrasonography and abdominal computed tomography. We reported here on one case of intramural duodenal hematoma and hemoperitoneum after performing endoscopic hemostasis in a chronic renal failure patient who was on maintenance hemodialysis. (Korean J Gastrointest Endosc 2007;34:269⁣273)

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A Case of the Endoscopic Removal of a Duodenal Heterotopic Gastric Mucosa Presenting as a Polypoid Lesion: Sung Hoon Kim, M.D., Seun Ja Park, M.D., Nang Hee Kim, M.D., Ji Hyeon Nam, M.D., Ji Eun Park, M.D., Seo Ryong Han, M.D., Won Moon, M.D., Kyu-Jong Kim, M.D., Moo In Park, M.D. and Min Jung Jung, M.D.*; Korean J Gastrointest Endosc 2007;34(3):146-150. Published online March 30, 2007

Abstract PDF: Ectopic gastric mucosa is known to occur throughout the gastrointestinal tract. Ectopic gastric mucosa in the duodenum is classified into the developmental (heterotopic gastric mucosa) and acquired types (gastric metaplasia). Gastric metaplasia may be present in up to 64% of normal individuals but heterotopic gastric mucosa is quite rare. A heterotopic gastric mucosa in the duodenum may be asymptomatic but can give rise to perforation, hemorrhage, and intestinal obstruction in rare cases. Therefore, periodic endoscopic surveillance is recommended in these cases. Endoscopically, the appearance of a heterotopic gastric mucosa shows a mainly elevated lesion with multiple nodularity. We report a case of 1.5⁓1.2 cm sized polypoid lesion of the duodenum in an asymptomatic 31 year-old man. The mass was resected endoscopically and diagnosed as a heterotopic gastric mucosa. (Korean J Gastrointest Endosc 2007;34:146⁣150)

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Upper Gastrointestinal Bleeding due to Direct Invasion of Hepatocellular Carcinoma to the Duodenum: Kyoung Ah Jung, M.D., Hyun Jin Kim, M.D., Sun Pil Choi, M.D., Jong Ha, M.D., Byong Ryol Lim, M.D., Tae Hyo Kim, M.D. and Ok Jae Lee, M.D.; Korean J Gastrointest Endosc 2006;33(5):298-302. Published online November 30, 2006

Abstract PDF: Although a metastasis to the gastrointestinal tract (GI) is rare in patients with hepatocellular carcinoma (HCC), it can occur by hematogenous or lymphatic spread, or by direct invasion of a tumor. A 61-year old woman who had a progressing large primary liver cancer presented with upper gastrointestinal (UGI) bleeding. UGI endoscopy showed a large duodenal submucosal tumor-like mass with a central ulcer and adherent blood clots. Endoscopic biopsy and coagulation using argon plasma probe were performed. The microscopic examination revealed a HCC. We report this unusual case of HCC with direct invasion of the duodenum. (Korean J Gastrointest Endosc 2006;33:298⁣302)

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