Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type polyp in the duodenum with ingrowth into the common bile duct: Case report

Solitary duodenal Peutz-Jeghers(PJ)-type hamartomatous polyps are rare and considered a different disease entity than classic PJ syndrome.We describe the case of an 89-year-old man admitted to our emergency department with symptoms of acute cholangitis,liver dysfunction,and slight jaundice.Magnetic resonance imaging showed multiple signal voids,reflecting choledocholithiasis,and an ovalshaped tumor in the common bile duct(CBD).Following endoscopic retrograde cholangiopancreatography,the patient was diagnosed with a lower CBD tumor 20 mm in diameter.Endoscopic sphincterotomy was performed for choledocholithotomy,resulting in the expulsion of a large tumor with a stalk connected to the papilla of Vater.The tumor was successfully excised en bloc by endoscopic snare papillectomy.Histopathologic examination showed that the tumor was a PJ-type hamartomatous polyp.No mucocutaneous pigmentation of the skin was evident and the patient's family history was negative.Solitary duodenal PJ-type hamartomatous polyps are usually diagnosed incidentally during endoscopy for other indications because most of these tumors are asymptomatic or have nonspecific presentations.To our knowledge,this is the first reported solitary PJ-type polyp with intra-CBD growth treated by endoscopic snare papillectomy.

Physical multimorbidity patterns and depressive symptoms:a nationwide cross-sectional study in Japan

Objective The associations of physical multimorbidity with depressive symptoms have been investigated in a number of studies.However,whether patterns of chronic physical conditions have comparatively different associations with depressive symptoms remains unclear.This study aimed to investigate the associations of physical multimorbidity patterns with depressive symptoms.Design This study was designed as a nationwide cross-sectional survey in Japan.setting General sample of the Japanese population.Participants Adult Japanese residents were selected by a quota sampling method.Data were analysed from 1788 residents who reported one or more chronic health conditions.results Among four physical multimorbidity patterns:cardiovascular-renal metabolic(CRM),skeletal-articular digestive(SAD),respiratory-dermal(RDE)and malignant-digestive urologic(MDU),multivariable logistic regression analyses revealed that the RDE pattern showed the strongest association with depressive symptoms(aOR=1.68,95%CI:1.21 to 2.31 for the pattern score highest quartile,compared with the lowest quartile),followed by SAD and MDU patterns(aOR=1.41,95%CI:1.01 to 1.98 for the SAD pattern score highest quartile;1.41,95%CI:1.01 to 1.96 for the MDU pattern score highest quartile,compared with the lowest quartile).In contrast,the CRM pattern score was not significantly associated with depressive symptoms(aOR=1.31,95%CI:0.90 to 1.89 for the pattern score highest quartile,compared with the lowest quartile).Conclusions Physical multimorbidity patterns have different associations with depressive symptoms.Among these patterns,patients with the RDE pattern may be at a higher risk for developing depressive symptoms.This study reinforces the evidence that cluster pattern of chronic health conditions is a useful measure for clinical management of multimorbidity as it is differently associated with mental health status,which is one of the crucial outcomes for multimorbid patients.