Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?

Due to the high risk of morbidity and mortality associated with surgical resection in this tract,endoscopic resection(ER)has taken the place of surgical resection as the first line treatment for non-ampullary duodenal adenomas.However,due to the anatomical characteristics of this area,which enhance the risk of post-ER problems,ER in the duodenum is particularly difficult.Due to a lack of data,no ER technique for superficial non-ampullary duodenal epithelial tumours(SNADETs)has yet been backed by strong,high-quality evidence;yet,traditional hot snare-based techniques are still regarded as the standard treatment.Despite having a favourable efficiency profile,adverse events during duodenal hot snare polypectomy(HSP)and hot endoscopic mucosal resection,such as delayed bleeding and perforation,have been reported to be frequent.These events are primarily caused by electrocautery-induced damage.Thus,ER techniques with a better safety profile are needed to overcome these shortcomings.Cold snare polypectomy,which has already been shown as a safer,equally effective pro-cedure compared to HSP for treatment of small colorectal polyps,is being increasingly evaluated as a potential therapeutic option for non-ampullary duodenal adenomas.The aim of this review is to report and discuss the early outcomes of the first experiences with cold snaring for SNADETs.

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions

Objective： The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography （CT） and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography （PUS） with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. Methods： Patients with duodenal protruding lesions who were indicated for PUS were examined by PUS with 12-15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of PUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of PUS. Those patients without endoscopic resection or surgical excision were periodically followed up with PUS. Results： A total of 169 patients with duodenal protruding lesions were examined by PUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner＇s gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After PUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of PUS, with 93.33% diagnostic accuracy. The results of follow-up with PUS indicated that duodenal cyst, Brunner＇s gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1-3 years. No related complications occurred among all patients that received PUS examinations. Conclusion： PUS is an effective and reliable diagnostic method for duodenal protruding lesions.

Bypassing major venous occlusion and duodenal lesions in rats, and therapy with the stable gastric pentadecapeptide BPC 157, L-NAME and L-arginine

AIM To investigate whether duodenal lesions induced by major venous occlusions can be attenuated by BPC 157 regardless nitric oxide(NO) system involvement.METHODS Male Wistar rats underwent superior anterior pancreaticoduodenal vein(SAPDV)-ligation and were treated with a bath at the ligated SAPDV site(BPC 157 10 μg, 10 ng/kg per 1 mL bath/rat; L-NAME 5 mg/kg per 1 m L bath/rat; L-arginine 100 mg/kg per 1 mL bath/rat, alone and/or together; or BPC 157 10 μg/kg instilled into the rat stomach, at 1 min ligation-time). We recorded the vessel presentation(filled/appearance or emptied/disappearance) between the 5 arcade vessels arising from the SAPDV on the ventral duodenum side, the inferior anterior pancreaticoduodenal vein(IAPDV) and superior mesenteric vein(SMV) as bypassing vascular pathway to document the duodenal lesions presentation; increased NO-and oxidative stress [malondialdehyde(MDA)]-levels in duodenum.RESULTS Unlike the severe course in the SAPDV-ligated controls, after BPC 157 application, the rats exhibited strong attenuation of the mucosal lesions and serosal congestion, improved vessel presentation, increased interconnections, increased branching by more than 60% from the initial value, the IAPDV and SMV were not congested. Interestingly, after 5 min and 30 min of L-NAME and L-arginine treatment alone, decreased mucosal and serosal duodenal lesions were observed; their effect was worsened at 24 h, and no effect on the collateral vessels and branching was seen. Together, L-NAME+L-arginine antagonized each other's response, and thus, there was an NO-related effect. With BPC 157, all SAPDV-ligated rats receiving L-NAME and/or L-arginine appeared similar to the rats treated with BPC 157 alone. Also, BPC 157 in SAPDV-ligated rats normalized levels of NO and MDA, two oxidative stress markers, in duodenal tissues.CONCLUSION BPC 157, rapidly bypassing occlusion, rescued the original duodenal flow through IAPDV to SMV flow, aneffect related to the NO system and reduction of free radical formation.

Application of endoscopic submucosal dissection in duodenal space-occupying lesions

BACKGROUNDEndoscopic submucosal dissection (ESD) has been advocated by digestiveendoscopists because of its comparable therapeutic effect to surgery, reducedtrauma, faster recovery, and fewer complications. However, ESD for lesions of theduodenum is more challenging than those occurring at other levels of thegastrointestinal tract due to the thin intestinal wall of the duodenum, narrowintestinal space, rich peripheral blood flow, proximity to vital organs, and highrisks of critical adverse events including intraoperative and delayed bleeding andperforation. Because of the low prevalence of the disease and the high risks ofsevere adverse events, successful ESD for lesions of the duodenum has rarelybeen reported in recent years.AIM To investigate the efficacy and safety of ESD in the treatment of duodenal spaceoccupyinglesions.METHODS Clinical data of 24 cases of duodenal lesions treated by ESD at the DigestiveEndoscopy Center of the Affiliated Hospital of Qingdao University from January2016 to December 2019 were retrospectively analyzed.RESULTS All of the 24 cases from 23 patients underwent ESD treatment for duodenal spaceoccupyinglesions under general anesthesia, including 15 male and 8 femalepatients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) inthe duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball descending junction. The mean diameter of the lesion was 12.75 (range, 11-22)mm. Thirteen lesions originated from the mucosa, of which 4 were low-gradeintraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1was tubular adenoma. Eleven lesions were in the submucosa, including 5neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymphfollicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24),including 4 submucosal protuberant lesions and 1 depressed lesion. The meanlength of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in allpatients, and no complications, such as infection and stenosis, were found duringthe follow-up period.CONCLUSION ESD is safe and effective in the treatment of duodenal lesions;however, theendoscopists should pay more attention to the preoperative preparation,intraoperative skills, and postoperative treatment.

Drug-induced mucosal alterations observed during esophagogastroduodenoscopy

Several features of drug-induced mucosal alterations have been observed in the upper gastrointestinal tract,i.e.,the esophagus,stomach,and duodenum.These include pill-induced esophagitis,desquamative esophagitis,worsening of gastroesophageal reflux,chemotherapy-induced esophagitis,proton pump inhibitor-induced gastric mucosal changes,medication-induced gastric erosions and ulcers,pseudomelanosis of the stomach,olmesartan-related gastric mucosal inflammation,lanthanum deposition in the stomach,zinc acetate hydrate tabletinduced gastric ulcer,immune-related adverse event gastritis,olmesartan-associated sprue-like enteropathy,pseudomelanosis of the duodenum,and lanthanum deposition in the duodenum.For endoscopists,acquiring accurate knowledge regarding these diverse drug-induced mucosal alterations is crucial not only for the correct diagnosis of these lesions but also for differential diag-nosis of other conditions.This minireview aims to provide essential information on druginduced mucosal alterations observed on esophagogastroduodenoscopy,along with representative endoscopic images.

Massive gastrointestinal bleeding caused by a Dieulafoy's lesion in a duodenal diverticulum:A case report

BACKGROUND Dieulafoy's lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa.There is usually no ulcer present in Dieulafoy's lesions and the overlying mucosa is most often normal.Bleeding caused by a Dieulafoy's lesion is usually urgent,massive,life-threatening and prone to recurrence.Dieulafoy's lesions have been reported throughout the digestive tract although the majority of them have been found in the upper digestive tract especially the stomach and duodenum.However,a Dieulafoy's lesion occurring inside a duodenal diverticulum is very rare.CASE SUMMARY A 74-year-old Asian male with epigastric pain,hematemesis and melena was admitted to our clinic.Before admission,the patient had vomited 500 m L of dark red blood,and passed 200 g of black tarry stool.Conservative management was first undertaken as the patient had not been fasting.However,hemorrhage recurred and the patient went into shock.Urgent endoscopy was performed and a diverticulum of 1.8 cm×1.2 cm×0.8 cm was found on the anterior wall of the descending duodenum.The diverticulum was covered with a blood clot.After the clot was removed,an artery stump was observed in the diverticulum with a diameter of 2-3 mm.Two titanium hemostatic clips were inserted to clamp the vessel stump.The patient was discharged 7 d post-endoscopy and followed for 6 mo with no recurrence.CONCLUSION This case was diagnosed with a Dieulafoy's lesion inside a duodenal diverticulum which has rarely been reported.Hematemesis was stopped by clamping the vessel stump with titanium clips.No complications occurred.

Endoscopic mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors

BACKGROUND The selection of endoscopic treatments for superficial non-ampullary duodenal epithelial tumors(SNADETs)is controversial.AIM To compare the efficacy and safety of endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)for SNADETs.METHODS We retrospectively analyzed the data of patients with SNADETs from a database of endoscopic treatment for SNADETs,which included eight hospitals in Fukuoka,Japan,between April 2001 and October 2017.A total of 142 patients with SNADETs treated with EMR or ESD were analyzed.Propensity score matching was performed to adjust for the differences in the patient characteristics between the two groups.We analyzed the treatment outcomes,including the rates of en bloc/complete resection,procedure time,adverse event rate,hospital stay,and local or metastatic recurrence.RESULTS Twenty-eight pairs of patients were created.The characteristics of patients between the two groups were similar after matching.The EMR group had a significantly shorter procedure time and hospital stay than those of the ESD group[median procedure time(interquartile range):6(3-10.75)min vs 87.5(68.5-136.5)min,P<0.001,hospital stay:8(6-10.75)d vs 11(8.25-14.75)d,P=0.006].Other outcomes were not significantly different between the two groups(en bloc resection rate:82.1%vs 92.9%,P=0.42;complete resection rate:71.4%vs 89.3%,P=0.18;and adverse event rate:3.6%vs 17.9%,P=0.19,local recurrence rate:3.6%vs 0%,P=1;metastatic recurrence rate:0%in both).Only one patient in the ESD group underwent emergency surgery owing to intraoperative perforation.CONCLUSION EMR has significantly shorter procedure time and hospital stay than ESD,and provides acceptable curability and safety compared to ESD.Accordingly,EMR for SNADETs is associated with lower medical costs.

Endoscopic diagnosis and treatment of superficial nonampullary duodenal tumors

The diagnostic and treatment guidelines of superficial non-ampullary duodenal tumors have not been standardized due to their low prevalence.Previous reports suggested that a superficial adenocarcinoma(SAC) should be treated via local resection because of its low risk of lymph node metastasis,whereas a highgrade adenoma(HGA) should be resected because of its high risk of progression to adenocarcinoma.Therefore,pretreatment diagnosis of SAC or HGA is important to determine the appropriate treatment strategy.There are certain endoscopic features known to be associated with SAC or HGA,and current practice prioritizes the endoscopic and biopsy diagnosis of these conditions.Surgical treatment of these duodenal lesions is often related to high risk of morbidity,and therefore endoscopic resection has become increasingly common in recent years.Endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) are the commonly performed endoscopic resection methods.EMR is preferred due to its lower risk of adverse events;however,it has a higher risk of recurrence than ESD.Recently,a new and safer endoscopic procedure that reduces adverse events from EMR or ESD has been reported.

Laparoscopic and endoscopic co-operative surgery for nonampullary duodenal tumors

AIM To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery(LECS) for early nonampullary duodenal tumors.METHODS Twelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small(less than 10 mm) submucosal tumors(SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection(ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique.RESULTS Two SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc. The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications(Clavien-Dindo classification grade Ⅲ or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient.CONCLUSION LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.

Effectiveness and safety of over-the-scope clip in closing perforations after duodenal surgery

BACKGROUND Endoscopic resection of duodenal subepithelial lesions(SELs)is a difficult procedure with a high risk of perforation.At present,dealing with perforation after endoscopic resection of duodenal SELs is still considered a great challenge.AIM To evaluate the effectiveness and safety of an over-the-scope clip(OTSC)in the treatment of perforation post-endoscopic resection of duodenal SELs.METHODS From May 2015 to November 2019,18 patients with perforation following endoscopic resection of duodenal SELs were treated with OTSCs.Data comprising the rate of complete resection,closure of intraprocedural perforation,delayed bleeding,delayed perforation,and postoperative infection were extracted.RESULTS The rate of complete removal of duodenal SELs and successful closure of the perforation was 100%.The median perforation size was 1 cm in diameter.Seventeen patients had minor intraoperative bleeding,while the remaining 1 patient had considerable amount of bleeding during the procedure.Seven patients had postoperative abdominal infections,of which 1 patient developed an abscess in the right iliac fossa and another patient developed septic shock.All 18 patients recovered and were discharged.No delayed bleeding or perforation was reported.The mean time taken to resume normal diet after the procedure was 6.5 d.The mean postoperative hospital stay was 9.5 d.No residual or recurrent lesions were detected during the follow-up period(15-66 mo).CONCLUSION Closing a perforation after endoscopic resection of duodenal SELs with OTSCs seems to be an effective and reasonably safe therapeutic method.

New hope for esophageal stricture prevention:A prospective singlecentertrial on acellular dermal matrix

BACKGROUNDGiven the high incidence of esophageal cancer in China,an increasing number ofpatients there are undergoing endoscopic mucosal dissection(ESD).Although the5-year survival rate after ESD can exceed 95%,esophageal stricture,the mostcommon and serious postoperative complication,affects the long-term prognosisof patients and the quality of life.Autologous mucosal grafts have proven to besuccessful in preventing stricture after ESD for early esophageal cancer.AIMTo examine the viability of acellular dermal matrix(ADM)as an alternative to autologous mucosa for the prevention of stricture after ESD.METHODSThis is a prospective,single-center,controlled study.Consecutive patients who underwent ESD surgery and werewilling to undergo autologous mucosal transplantation were recruited between January 1 and December 31,2017.Consecutive patients who underwent ESD surgery and were willing to undergo ADM transplantation wererecruited between January 1 to December 31,2019.A final three-year follow-up of patients who receivedtransplants was conducted.RESULTSBased on the current incidence of esophageal stricture,the sample size required for both the autologous mucosalgraft group and the ADM group was calculated to be 160 cases.Due to various factors,a total of 20 patients withautologous mucosal grafts and 25 with ADM grafts were recruited.Based on the inclusion exclusion andwithdrawal criteria,9 patients ultimately received autologous mucosal grafts and completed the follow-up,while11 patients received ADM grafts and completed the follow-up.Finally,there were 2 cases of stenosis in theautologous mucosal transplantation group with a stenosis rate of 22.22%and 2 cases of stenosis in the ADMtransplantation group with a stenosis rate of 18.18%,with no significant difference noted between the groups(P=0.94).CONCLUSIONIn this prospective,single-center,controlled trial,we compared the effectiveness of autologous mucosatransplantation and ADM for the prevention of esophageal stricture.Due to certain condition limitations,we wereunable to recruit sufficient subjects meeting our target requirements.However,we implemented strict inclusion,exclusion,and withdrawal criteria and successfully completed three years of follow-up,resulting in valuableclinical insights.Based on our findings,we hypothesize that ADM may be similarly effective to autologousmucosal transplantation in the prevention of esophageal stricture,offering a comparable and alternative approach.This study provides a new therapeutic idea and direction for the prevention of esophageal stricture.

低张水成像联合多模态磁共振成像应用于十二指肠原发性肿瘤及肿瘤样病变诊断中的价值分析

目的探讨低张水成像联合多模态磁共振成像(MRI)应用于十二指肠原发性肿瘤及肿瘤样病变诊断中的价值。方法回顾性分析我院在2015年1月至2021年12月期间经病理诊断为十二指肠病变的44例患者资料,所有患者均接受了低张水成像联合多模态MRI检查,根据病理诊断结果将患者分为良性组(十二指肠肿瘤样病变)和恶性组(十二指肠原发性肿瘤病变),分别有28例、16例。记录2组的病理结果,分析对比2组的多模态MRI功能评分、多模态MRI形态评分。结果2组的表观弥散系数(ADC)值、时间-信号强度曲线(TIC)曲线类型分布差异有统计学意义(P<0.05)。2组的肿块形态、管壁柔软、黏膜、组织浸润、转移病灶对比差异有统计学意义(P<0.05)。结论低张水成像联合多模态MRI可根据肿块形态、管壁柔软度、黏膜情况等鉴别十二指肠原发性肿瘤与肿瘤样病变,其中原发性肿瘤的ADC值较肿瘤样病变低,且TIC以Ⅲ型为主。

内镜下局部切除十二指肠乳头病变治疗的研究

目的 :探讨内镜下局部切除十二指肠乳头病变方法的安全性及疗效。方法 :内镜下采用圈套器对 7例确诊为十二指肠乳头病变患者取病变乳头进行电凝切除 ,部分患者切除后为防止胰管或胆管狭窄放置内支架 ,切除后标本送病理检查 ,定期随访。结果 :7例病变全部完整切除。病理结果为腺瘤 2例 ,局部高度不典型增生 3例 ,乳头癌 2例。治疗后黄疸短期内明显降低 ,胰腺炎无复发。无明显并发症发生。结论 :内镜下十二指肠乳头切除术 ,对于十二指肠乳头腺瘤、局部不典型增生、早期肿瘤等疗效肯定 。

内镜下治疗十二指肠占位性病变的安全性、有效性及临床价值研究

目的评价内镜下治疗十二指肠占位性病变的安全性、有效性及临床价值。方法回顾性分析2012年12月-2016年12月南京医科大学第二附属医院消化内镜中心59例行内镜下治疗的十二指肠占位性病变患者的临床资料。结果 59例患者接受内镜下黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)治疗,男31例,女28例,年龄17~81(58.2±13.3)岁。病变位于十二指肠球部24例(40.68%),降部35例(59.32%)。病灶直径0.2~5.0(1.4±0.9)cm。病变来源于黏膜层39例(66.10%),包括炎性或增生性息肉18例,绒毛状-管状腺瘤6例,高级别上皮内瘤变5例及其他。来源于黏膜下层的病变者20例(33.90%),包括布氏腺瘤4例,异位胰腺5例,脂肪瘤4例,间质瘤4例,神经内分泌瘤2例,平滑肌瘤1例。术中穿孔5例,术后迟发性出血4例,经术中修补及术后止血治疗,无再发穿孔及出血。2例患者追加外科手术治疗。59例患者均接受了3~30个月的术后随访,随访期间无1例复发。结论内镜下治疗十二指肠占位性病变具有可靠的临床疗效,术后并发症发生率低,患者术后恢复好。该技术安全、有效,值得推广应用。

十二指肠球部隆起病变97例内镜与病理学观察

目的 通过病理组织学诊断探讨十二指肠球部隆起性病变内镜检查的意义。方法 收集2009年7月20日至2011年5月20日共20个月期间检查的十二指肠球部隆起性病变97例,比较内镜下诊断与病理学检查的关系。结果 ①内镜下表现可分为息肉样隆起与颗粒样增生改变两类。②病理学对十二指肠球部病变的诊断包括：胃黏膜异位25例（25.8%）,十二指肠慢性炎症62例（63.9%）,布氏腺增生9例（9.3%）,管状腺瘤1例（1.0%）。③本组病例十二指肠球部隆起性病变的检出率为1.05%（97/9 186）,与整体病例比较无性别间差异（P〉0.1）;患者年龄范围在19-85岁之间。“布氏腺增生”组患者年龄与其余两组有统计学差异（P〈0.05-0.001）,管状腺瘤组因仅1例而未做比较。④幽门螺杆菌感染率在各组间无统计学差异（χ^2=5.12,P〉0.05）;内镜其他诊断结果与病理学诊断结果之间也无统计学差异（χ^2=23.63,P〉0.05）。⑤在十二指肠球部病变内镜观察与病理学诊断之间存在统计学差异（χ^2=9.68,P〈0.05）,内镜下观察到的息肉样增生及颗粒样增生改变在病理学诊断的各组之间比率不同。⑥十二指肠球部胃黏膜异位的25例患者中有3例发生食管癌。结论 十二指肠球部隆起病变在内镜下表现为息肉样改变或颗粒样增生改变,但明确诊断需要取黏膜组织做病理学明确诊断。病理组织学可表现为胃黏膜异位、十二指肠慢性炎、布氏腺增生及腺瘤样改变。

十二指肠降部黏膜下层隆起性病变17例临床分析

目的探讨十二指肠降部黏膜下层隆起性病变的临床、内镜超声及病理特点。方法对17例十二指肠降部黏膜下层隆起性病变采用Olympus GIF H260型胃镜及Olympus UM-25R型及UM-3R型微探头超声胃镜确定病变层次、范围、超声特点后,17例均行内镜下"全瘤"活检术及套扎术加部分活检术。超声频率为:20MHz,高频电发生器为:YH300A。结果十二指肠降部黏膜下层隆起性病变以降部外侧壁及乳头旁多见,组织病理学结果示:脂肪瘤5例,十二指肠腺腺瘤4例,慢性炎性增生3例,神经节细胞性副神经节瘤2例,淋巴管瘤1例,错构瘤1例,囊肿1例。结论十二指肠隆起性病变以脂肪瘤和腺瘤多见,其次为炎性增生等。

十二指肠球部及降部隆起性病变的内镜分析及临床意义

目的通过对十二指肠球部及降部的隆起性病变的内镜分析,提高人们对该病变的认识。方法经电子胃镜、十二指肠镜、超声内镜、ERCP等检查方法,共检出十二指肠球部及降部的隆起性病变1 187例,对其进行内镜分析。结果本组十二指肠球部及降部隆起性病变共1 187例,其中息肉981例,恶性肿瘤69例,间质瘤53例,异位胰腺31例,囊肿27例,脂肪瘤26例,所占比例分别为82.65%、5.81%、4.47%、2.61%、2.27%、2.19%。981例息肉中,经病理证实肿瘤性息肉137例,占13.97%(137/981)。60 748例上消化道内镜检查中恶性肿瘤69例,其发生率为0.11%(69/60 748)。结论十二指肠球部及降部隆起性病变中息肉最为常见,其中肿瘤性息肉所占比例远高于文献报道,恶性肿瘤的发生率也较以前增加,人们应提高对十二指肠球部及降部隆起性病变的警惕。

十二指肠乳头占位病变26例临床诊疗分析

目的探讨十二指肠乳头癌的临床诊断特点,提高对十二指肠乳头癌的认识及诊断水平,做到早期诊疗.方法回顾性分析26例十二指肠乳头占位疾病者的临床资料,总结诊疗经验.结果十二指肠乳头占位以腺癌最常见,占88.5%(22/26)其次为乳头腺瘤,占11.5%(3/26).首发症状以黄疸最常见,为76.9%(20/26),其次为腹痛,占26.9%(7/26);B超、CT和MRCP检查可发现胆管扩张,有助诊断,ERCP可明确肿瘤的具体位置和形态.腺瘤行乳头切除成形或Whipple术式者远期生存良好,腺癌行Whipple术式者1 a生存率为55.6%,放弃手术者或姑息性胆肠吻合者1 a生存率为0.结论十二指肠占位早期诊断困难,乳头切除成形是治疗腺瘤的首选方式,Whipple术式是腺癌的首选方式;重视胆道疾病影像检查是早期发现十二指肠乳头占位病变的有效方法.

窄带成像技术对十二指肠非壶腹部表浅隆起型病变诊断价值的研究

目的探讨窄带成像技术(NBI)在十二指肠非壶腹部表浅隆起型病变诊断中的应用价值。方法搜集胃镜诊断十二指肠非壶腹部表浅隆起型病变为研究对象,根据病理诊断分组,NBI模式下观察病变分布、融合、直径、血管结构(VP)和表面结构(SP),比较不同组间各项观察指标是否存在差异。结果共搜集表浅型隆起病变72例,35例(48.61%)为炎症,17例(23.61%)为胃黏膜异位,12例(16.67%)为胃上皮化生,8例(11.11%)为腺瘤。4种病变中,腺瘤易单发、直径更大,炎症病变SP多与周边黏膜一致,VP及融合对部分病变的鉴别具有一定提示作用。结论应用NBI可以对十二指肠非壶腹部表浅隆起型病变进行初步鉴别,从而引导靶向性活检,提高诊断准确性及阳性率。

内镜窄带成像技术对十二指肠胃上皮化生和胃黏膜异位诊断价值的研究

目的探讨内镜窄带成像(NBI)技术对十二指肠胃上皮化生和胃黏膜异位的诊断价值。方法选择十二指肠胃上皮化生/胃黏膜异位和炎性表浅隆起型病变为研究对象,记录患者性别、年龄,在内镜NBI模式下观察病变分布、多发病变间融合、病变大小、病变血管结构和表面结构,比较两组的各项观察指标是否存在差异。结果 72例研究对象中,胃上皮化生/胃黏膜异位组35例(48.61%),炎性反应组37例(51.39%),单因素和多因素分析均提示,两组间性别、年龄、病变分布、多发病变间融合、病变大小和病变血管结构的差异均无统计学意义(P均>0.05),病变黏膜表面结构的差异有统计学意义(P<0.05)。结论应用内镜NBI技术,可对十二指肠胃上皮化生和胃黏膜异位与炎性病变进行初步鉴别,从而引导靶向性活组织检查,可提高诊断准确性。