Association Between Antispasmodics and Detection of Lesions By Screening Esophagogastroduodenoscopy

Background and Aim: Whether administration of antispasmodics as a component of premedication contributes to detection of lesions by screening esophagogastroduodenoscopy (EGDS) remains unclear. Our primary aim was to investigate this possibility.Methods: The cohort of this retrospective study comprised consecutive cases who had undergone screening EGDS at the Japanese Red Cross Wakayama Medical Center from October 2015 to September 2020. The investigated lesions comprised esophageal squamous cell carcinoma or adenocarcinoma, gastric adenoma or adenocarcinoma, and duodenal adenoma or adenocarcinoma.Results: Targeted lesions were detected in 72 of 31484 participants (0.23%), 18260 and 13224 of whom had received and not received pre-procedure antispasmodic agents, respectively. The rates of detection of lesions in these groups were 0.21% (38/18260) and 0.26% (34/13224), respectively (P = 0.40). Multivariate logistic regression analysis showed no association between administration of antispasmodics and rates of detection of targeted lesions (P = 0.12). Conclusions: Antispasmodics, which were administered to more than half of the study cohort, did not improve the rate of detection of targeted lesions.

ESD-aid Surgery as a New Treatment Strategy for Duodenal Adenoma

BackgroundThe treatment for nonampullary duodenal adenoma remains to have no consensus and established methods. Although endoscopic treatment is minimally invasive, it was reported to cause delayed perforation in more than 20% of cases. MethodsFor adenomas in the duodenum, we have performed ESD-aid surgery, which is a procedure to prophylactically suture the seromuscular structure of the duodenum after ESD. In this procedure, we did not perform Kocher mobilization prior to ESD to facilitate endoscopic resection and full-thickness resection to prevent spread of the tumor and infection to the abdominal cavity. The duodenal wall was reinforced in planes using a suture clip. ResultsOf the 13 cases of duodenal adenoma that underwent ESD-aid surgery at our hospital between April 2018 and December 2020, 1 developed postoperative bleeding, but there was no late perforation. ConclusionsFor duodenal adenomas, ESD-aid surgery was considered a safe and minimally invasive treatment.Trial registrationThis research was approved by the institutional review board of Nagoya City University Hospital, Approval Number: 60-19-0021, Approval Date: 4 June 2019.

Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Main recommendations 1 ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.Strong recommendation, low quality evidence. 2 ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.Strong recommendation, low quality evidence. 3 ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.Strong recommendation, moderate quality evidence. 4 ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.Strong recommendation, low quality evidence. 5 ESGE suggests cold snare polypectomy for small (< 6 mm in size) nonmalignant duodenal adenomas.Weak recommendation, low quality evidence. 6 ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.Strong recommendation, moderate quality evidence. 7 ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.Strong recommendation, low quality evidence. 8 ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.Strong recommendation, low quality evidence. 9 ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result. Strong recommendation, low quality evidence.

Russell Body Duodenitis In A Patient With Duodenal Adenoma And High-Grade Dysplasia

Introduction/Objective Russell bodies are nondegradable, condensed immunoglobulins accumulated in the overstimulated plasma cells, and the plasma cells filled with Russell bodies are called Mott cells. Russell body gastroenteritis is a rare entity that is mainly occurs in stomach and is associated with Helicobacter pylori infection. However, Russell body duodenitis is very rarely seen, so far only about four cases have been reported. Here we report a case of Russell body duodenitis within concurrent large duodenal adenoma with high-grade dysplasia in a 66- year old female. Methods Formalin fixed, paraffin embedded tissue was examined stained with H&E and PAS-Alcian blue stain. Immunohistochemical stains (IHC) with appropriate controls were performed with the following antibodies: H. pylori, CD138, kappa and lambda light chains. Results A 66-year old female had symptoms of difficult swallowing and decreased food intake. Upper GI endoscopy was performed to reveal a 7 cm multilobulated mass at the junction of the duodenal bulb and second portion of the duodenum, which involved the ampullary orifice. A biopsy for the mass showed a duodenal adenoma with high grade dysplasia. Numerous Mott cells were diffusely distributed within the lamina propria that was characterized by bright eosinophilic cytoplasmic globules with eccentric nuclei. The Mott cells were confirmed by IHC stains with positive CD138, PAS-Alcian blue, and polytypic expression of kappa and lambda light chains. The Helicobacter pylori immunostain was negative. Conclusion Although the etiology is unknown, most of the Russell body gastroenteritis are seen in benign conditions. It is mainly found in stomach associated with Helicobacter pylori infection. To our knowledge, this is the first reported case of Russell body duodenitis with concurrent duodenal adenoma with high-grade dysplasia. Further studies should be conducted on Russell bodies associated with high-grade dysplasia or carcinoma in gastrointestinal tract.

A Rare Manifestation of a Bleeding Tubulovillous Duodenal Polyp Presenting as an Upper Gastrointestinal Hemorrhage

Duodenal polyps have been reported in <1.5% of individuals who undergo esophagogastroduodenoscopy (EGD). We present a case of a 76-year-old male with recurrent hematemesis who was found to have an intestinal-type, pedunculated tubulovillous adenoma in the descending duodenum. An isolated occurrence of nonampullary sporadic duodenal adenoma is a rare finding. Presentation as an upper gastrointestinal hemorrhage is also extremely uncommon. Our patient’s polyp was pedunculated, which is atypical, because most sporadic duodenal adenomas are morphologically flat or sessile. The purpose of this case is to present a rare cause of upper gastrointestinal bleeding and to depict characteristics of an isolated duodenal tubulovillous adenoma and its treatment options.