Korean Journal of Gastrointestinal Endoscopy 2005;31(4): 211-215.
첫 상부 위장관 내시경 검사에서 진단하지 못한 십이지장의 원발성 악성 종양
신동현·이준행·강태욱·김 정·최용성·박문경·손경목·이풍렬·김재준·백승운·이종철
성균관대학교 의과대학 삼성서울병원 소화기내과
Primary Duodenal Malignant Tumors Missed at Initial Upper Endoscopy
Dong Hyun Sinn, M.D., Jun Haeng Lee, M.D., Tae Wook Kang, M.D., Jeong Kim, M.D., Yong Sung Choi, M.D., Moon Kyung Park, M.D., Kyung-Mok Sohn, M.D., Poong-Lyul Rhee, M.D., Jae J. Kim, M.D., Seung Woon Paik, M.D. and Jong Chul Rhee, M.D.
Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
Abstract
Background/Aims: Upper endoscopy is an effective method for diagnosing duodenal cancer, however endoscopy sometimes overlook the lesion. Methods: We did a retrospective review of sixty-eight patients with non-ampullary primary malignant duodenal tumors treated at Samsung Medical Center between 1994 to 2003. Thirteen of 68 patients (20%), whom were not diagnosed by initial endoscopy were analyzed. Results: Twelve were male and mean age were 52.7⁑11.4 years. Histopathologic analysis revealed adenocarcinoma in 10 patients, stromal tumor 2, and lymphoma 1. Weight loss, abdominal pain, bleeding, and vomiting were the presenting symptoms. Initial endoscopy missed the lesion in 9 patients. In 5 patients, location of the lesions were third and fourth portion of the duodenum, difficult to be locations seen by usual endoscopic examination. Four were in the duodenal second portion, and undiagnosed without specific reason. The lesions were seen at initial endoscopy in 4 patients, however biopsy was done in only one patient because the lesion was considered as benign, initially. The median interval to diagnosis from initial upper endoscopy were 35 days (7∼109 days). Conclusions: Some duodenal lesions were missed at initial endoscopic examination. Our study suggests that it is crucial to examine beyond the duodenal bulb and biopsy should be considered when the lesion is not typically looking as benign. (Korean J Gastrointest Endosc 2005;31:211215)
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