Duodenal Bulb Adenocarcinoma Benefitted from Neoadjuvant Chemotherapy: A Case Report

Chemotherapy ◽  
2017 ◽  
Vol 62 (5) ◽  
pp. 290-294 ◽  
Author(s):  
Geng-Yuan Zhang ◽  
Jie Mao ◽  
Bin Zhao ◽  
Bo Long ◽  
Hao Zhan ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Comprehensive Evaluation ◽  
Duodenal Bulb ◽  
Treatment Modalities ◽  
Pathological Examination ◽  
Upper Gastrointestinal Endoscopy ◽  
Tumor Type ◽  
Low Incidence ◽  
Rare Malignancy ◽  
Upper Gastrointestinal

Duodenal bulb adenocarcinoma is an extremely rare malignancy in the alimentary tract which has a low incidence rate and nonspecific symptoms. It is difficult to diagnose early, and the misdiagnosis rate is high. CT, MRI, upper gastrointestinal endoscopy, and other advanced imaging modalities should be combined to make a comprehensive evaluation. The diagnostic confirmation of this tumor type mainly depends on the pathological examination. The combination of surgery with other treatment modalities is effective. A review of reports on duodenal bulb adenocarcinoma with chemotherapy revealed 6 cases since 1990. However, there are few reports on neoadjuvant chemotherapy for the disease. In this report, preoperative S-1 in combination with oxaliplatin neoadjuvant chemotherapy achieved a complete pathological response in the treatment of duodenal bulb adenocarcinoma. Neoadjuvant chemotherapy shows a better clinical efficacy in the treatment of duodenal bulb adenocarcinoma, but its value needs to be further verified.

scholarly journals Ligation assisted endoscopic mucosal resection of neuroendocrine tumor of duodenal bulb: a case report with a follow up of 24 months

2019 ◽  
Vol 8 (1) ◽  
pp. 18-20
Author(s):  
Umid Kumar Shestha ◽  
Gopi Aryal
Keyword(s):  
Neuroendocrine Tumor ◽  
Distant Metastasis ◽  
Gastrointestinal Endoscopy ◽  
Duodenal Bulb ◽  
Upper Gastrointestinal Endoscopy ◽  
Solitary Lesion ◽  
Free Margin ◽  
Mucosal Resection ◽  
Upper Gastrointestinal

Duodenal neuroendocrine tumor (NET) is a rare solitary lesion arising from the mucosa and submucosa of the duodenum, which is found incidentally during upper gastrointestinal endoscopy. Eendoscopic Mucosal Resection (EMR) has been the commonly used endoscopic procedure for duodenal carcinoid tumors, but the conventional EMR done to resect duodenal NET s is likely to have positive vertical margins. However, the ligation assisted EMR has recently been shown to be a promising technique for the treatment of duodenal NET that can have a negative free margin. In our study, we present a patient of 51-year-old male, who presented with pain over epigastrium and upper gastrointestinal endoscopy revealed a small submucosal lesion of 10 mm in the duodenal bulb. The endoscopic ultrasound showed the lesion arising from the echo layer three. The biopsy was taken which showed the duodenal NET. The computed tomography of abdomen did not show any evidence of distant metastasis. The EMR of duodenal NET was done by band ligation technique. The biopsy from the resected duodenal lesion confirmed the duodenal NET with the margin free of the tumor. The patient was followed at 6, 12, 18 and 24 months. During the follow up visits, the repeat upper gastrointestinal endoscopy did not show recurrence of the lesion and there was no any evidence of distant metastasis either. Ligation assisted EMR is an acceptable treatment in the hands of expert for small duodenal NET without the evidence of metastasis and can ensure the complete removal of the lesion with vertical free margin.

scholarly journals Composite detection rate as an upper gastrointestinal endoscopy quality measure correlating with detection of neoplasia

2021 ◽  
Author(s):  
Marcin Romańczyk ◽  
Bartosz Ostrowski ◽  
Tomasz Marek ◽  
Tomasz Romańczyk ◽  
Małgorzata Błaszczyńska ◽  
...  
Keyword(s):  
Detection Rate ◽  
Duodenal Bulb ◽  
General Setting ◽  
Quality Measure ◽  
University Hospital ◽  
Gastrointestinal Neoplasms ◽  
Upper Gastrointestinal Endoscopy ◽  
Group 4 ◽  
Upper Gastrointestinal ◽  
Group 1

Abstract Background Esophagogastroduodenoscopy (EGD) is commonly used diagnostic method with no widely accepted quality measure. We assessed quality indicator—composite detection rate (CDR)—consisting of detection of at least one of the following: cervical inlet patch, gastric polyp and post-ulcer duodenal bulb deformation. The aim of the study was to validate CDR according to detection rate of upper gastrointestinal neoplasms (UGN). Methods It was a multicenter, prospective, observational study conducted from January 2019 to October 2019. The endoscopic reports from 2896 symptomatic patients who underwent diagnostic EGD were analyzed. The EGDs were performed in three endoscopy units located in tertiary university hospital, private outpatient clinic and local hospital. Results 64 UGNs were detected. The mean CDR was 21.9%. The CDR correlated with UGN detection rate (R = 0.49, p = 0.045). Based on CDR quartiles, operators were divided into group 1 with CDR < 10%, group 2 with CDR 10–17%, group 3 with CDR 17.1–26%, and group 4 with CDR > 26%. Detection rate of UGN was significantly higher in the group 4 in comparison to group 1 (OR 4.4; 95% CI 2.2 − 9.0). In the multivariate regression model, patient age, male gender and operator’s CDR > 26% were independent risk factors of UGN detection (OR 1.03; 95% CI 1.01 − 1.05, OR 2; 95% CI 1.2 − 3.5, and OR 5.7 95% CI 1.5 − 22.3, respectively). Conclusions The CDR is associated with the detection of upper gastrointestinal neoplasms. This parameter may be a useful quality measure of EGD to be applied in general setting.

scholarly journals Protein losing gastroenteropathy due to Helicobacter pylori infection without giant rugal folds, erosion or polyposis

2019 ◽  
Vol 12 (11) ◽  
pp. e230870
Author(s):  
Katsunobu Yoshioka ◽  
Masanori Kishibuchi ◽  
Ko Takada
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Clinical Symptoms ◽  
Duodenal Bulb ◽  
Human Albumin ◽  
Gastric Body ◽  
Upper Gastrointestinal Endoscopy ◽  
Endoscopic Findings ◽  
Urease Test ◽  
H Pylori ◽  
Upper Gastrointestinal

An 85-year-old woman was admitted to our hospital because of progressive hypoproteinemia and generalised oedema. Technetium-99m human albumin scintigraphy revealed protein leakage in the gastrointestinal tract. Upper gastrointestinal endoscopy revealed small whitish nodules from the gastric body up to the duodenal bulb. The urease test for Helicobacter pylori infection was positive. We diagnosed her as having protein-losing gastroenteropathy (PLGE) caused by H. pylori infection. The patient’s hypoproteinemia and clinical symptoms promptly resolved after H. pylori eradication. Our results suggest that a trial of H. pylori eradication is warranted in patients with PLGE, even if endoscopy reveals neither giant rugal folds, erosion of the mucosa, nor polyposis, which are previously reported characteristic endoscopic findings of PLGE.

PS02.247: TWO CASES OF NEUROENDOCRINE CARCINOMA OF ESOPHAGOGASTRIC JUNCTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 193-193
Author(s):  
L E O Yamada ◽  
Shinji Ohki ◽  
Daisuke Ujiie ◽  
Takeshi Tada ◽  
Hiroyuki Hanayama ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Gastrointestinal Endoscopy ◽  
Pathological Examination ◽  
Medical Institute ◽  
Upper Gastrointestinal Endoscopy ◽  
Muscularis Mucosa ◽  
Cell Type ◽  
Paraaortic Lymph Nodes ◽  
Upper Gastrointestinal

Abstract Background Neuroendocrine cell carcinoma (NEC) of the esophagogastric junction is rare and usually has a very poor prognosis. Methods Here we present two cases of NEC occurred in the esophagogastric junction. Results Case 1 A 50-year-old man was admitted to the introduction origin medical institute with an abdominal pain and dysphagia. Upper gastrointestinal endoscopy revealed a type 2 tumor at the esophagogastric junction, and the pathological examination showed the diffuse proliferation of relatively homogeneous tumor cell with chromatin-enriched nuclear and immunohistologically, the tumor cells were positive for Chromogranin A, CD56, AE1/3. MIB-1 index was 80%, we diagnosed neuroendocrine carcinoma (small cell type). TNM Stage was GE, Type 3, cT4, cN1, cM0 cStage IIIB (ENETS TNM classification) He had undergone total gastrectomy and lower esophagectomy with transhiatal approach and 2 field of lymph node dissection. Pathological examination revealed NEC component developed under the muscularis mucosa, differentiated adenocarcinoma localized upper the muscularis mucosa and Chromogranin A positive cells were scattered inside. Pathological findings showed NEC (MIB-1 72.5%) with tub1, 70 × 56 mm, pT3 pN1(7/36), stage IIIB (HER2 score0). Adjuvant chemotherapy using S-1 was started, but the follow up CT showed recurrence in mediastinum, left subclavian and paraaortic lymph nodes 7 months after surgery. S-1 followed by CPT-11 + CDDP, CT showed the shrinkage of paraaortic lymph nodes metastasis. The patient alive for 55 months without any evidence ofprogression being continued chemotherapy. Case 2 A 57-year-old man was admitted to the introduction origin medical institute with dysphagia. Upper gastrointestinal endoscopy revealed a type 2 tumor at the esophagogastric junction, and the pathological examination showed NEC (small cell type). CT and PET revealed mediastinal lymph node metastasis, aortic invasion and adrenal metastasis. TNM stage was NEC, EG, cT3, cN1, cM1 cStage IV. We performed a systemic chemotherapy with CPT-11 + CDDP, the evaluation of treatment effect after 5 course chemotherapy revealed partial response. However the patient underwent the endoscopic stent graft due to stenosis, and died due to progressive disease 18months after chemotherapy induction. Conclusion We reported here two cases of NEC occurring in the esophagogastric junction. It's clinical behavior remains unclear and the treatment strategy for NEC of esophagogastric junction is not established. Further investigation of accumulated cases of this rare entity is necessary. Disclosure All authors have declared no conflicts of interest.

scholarly journals Pre-Endoscopy Drink of Simethicone and N-Acetylcysteine Significantly Improves Visualization in Upper Gastrointestinal Endoscopy

2021 ◽  
Vol 12 (01) ◽  
pp. 011-018
Author(s):  
Shrihari Anil Anikhindi ◽  
Ashish Kumar ◽  
Noriya Uedo ◽  
Vikas Singla ◽  
Akshay Anikhindi ◽  
...  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Duodenal Bulb ◽  
Gastric Fundus ◽  
Gastric Body ◽  
Upper Gastrointestinal Endoscopy ◽  
Optimal Outcomes ◽  
The Mean ◽  
The Difference ◽  
Upper Gastrointestinal ◽  
Control Study

Abstract Introduction With the advancements in diagnostic and therapeutic upper gastrointestinal endoscopy (UGIE), clear mucosal visualization is essential to ensure optimal outcomes. Though routinely followed in Japan and Korea, pre-endoscopic preparation is seldom used in India. We evaluated the efficacy of a pre-endoscopic drink of N-acetylcysteine (NAC) and simethicone in improving mucosal visibility during UGIE. Patients and Methods This study was a retrospective, investigator blind study with a case–control study design. Cases included patients who received a pre-endoscopy drink of NAC and simethicone in 100 mL water administered 10 to 30 minutes prior to UGIE. Controls only had mandatory fasting for 6 to 8 hours prior to UGIE. Propensity score matching was done to ensure comparability between the groups. Digital images were taken at six standard landmarks during UGIE and stored. A blinded investigator subsequently analyzed the images and rated the mucosal visibility on a 3-point scale. The difference in the mean mucosal visibility between the cases and controls was compared. Results Mean mucosal visibility during UGIE was significantly better using NAC with simethicone as compared with no preparation at esophagus (1.14 [0.37] vs. 1.47 [0.62], p < 0.05), gastric fundus (1.10 [0.30] vs. 1.55 [0.64], p < 0.05), gastric body (1.22 [0.50] vs. 1.62 [0.73], p < 0.05), gastric antrum (1.13 [0.37] vs. 1.47 [0.62], p < 0.05), and duodenal bulb (1.13 [0.34] vs. 1.33 [0.56], p < 0.05). In distal duodenum, though visibility improved with NAC with simethicone, the difference was insignificant. There were no adverse events related to the pre-endoscopy drink. Conclusion A pre-endoscopy drink of NAC with simethicone can significantly improve mucosal visibility during UGIE. It is safe, cheap, easily available and maybe considered for routine utilization for ensuring optimal endoscopic outcomes.

EP.WE.718An audit of the photographic documentation of upper gastrointestinal endoscopy at Cork University Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Stephen O'Brien ◽  
Niamh Foley ◽  
Amy Edwards Murphy ◽  
Morgan McCourt ◽  
Shane Killeen ◽  
...  
Keyword(s):  
Performance Indicator ◽  
Duodenal Bulb ◽  
University Hospital ◽  
British Society ◽  
Gastric Body ◽  
Upper Gastrointestinal Endoscopy ◽  
Anatomical Landmarks ◽  
Technical Failure ◽  
Photographic Documentation ◽  
Upper Gastrointestinal

Abstract Introduction A joint statement by the British Society of Gastroenterology and the Association of Upper Gastrointestinal Surgeons in 2017 recommended that photographic documentation of relevant anatomical landmarks should be a Key Performance Indicator of oesophagogastroduodenoscopy (OGD). The aim of this study was to assess this photodocumentation standard among surgeons and gastroenterologists in a tertiary referral centre. Methods Cork University Hospital endoscopy unit records were examined for a 2-month period from 01/10/20-27/11/20. OGDs were performed by 3 consultant colorectal surgeons and 4 consultant gastroenterologists over the time period. Demographic data and photodoumentation information were obtained from the Endoraad GI reporting tool. Surgeons and gastroenterologists performances was compared using the chi-squared test. Results 104 OGDs were analysed. Fifty-three (51%) OGDs were performed in women and 51(49%) OGDs were performed by surgeons. The documentation for each site was; gastro-oesophageal junction- 68% (69/102), fundus on retroflexion- 71% (72/102), gastric body- 32% (33/102), antrum- 61% (62/102), and duodenal bulb- 35% (36/102), without significant differences (p &gt; 0.05) for these sites between surgeons and gastroenterologists. There was more documentation of the upper oesophagus by surgeons (31% vs.12%, p = 0.030) and there was more documentation of the distal duodenum by gastroenterologists (90% vs.47%, p &lt; 0.01). Pictures were unable to be saved in two patients due to technical failure. Discussion Photodocumentation is increasingly important from a medico-legal viewpoint. There is room for improvement in our centre, but these rates are comparable to other published series. An educational session is being planned and following this adherence to photodocumentation standards will be re-examined.

scholarly journals Endoscopic resection of a giant symptomatic Brunner’s gland hamartoma of duodenal bulb

2019 ◽  
Vol 8 (2) ◽  
pp. 30-32
Author(s):  
Umid Kumar Shrestha ◽  
Gopi Aryal
Keyword(s):  
Duodenal Bulb ◽  
Complete Removal ◽  
Endoscopic Polypectomy ◽  
Upper Gastrointestinal Endoscopy ◽  
Polypoidal Mass ◽  
Brunner’S Gland ◽  
Brunner's Gland ◽  
Duodenal Lumen ◽  
Brunner’S Gland Hamartoma ◽  
Upper Gastrointestinal

Brunner's gland hamartoma is a very rare benign tumor arising from the Brunner’s gland of duodenum and is usually asymptomatic, but may present with the symptom of duodenal obstruction or upper gastrointestinal bleeding due to ulceration from the tumor, requiring endoscopic or surgical resection. In our study, we report the case of a 57 year-old male who presented with pain over epigastrium, recurrent vomiting, black stool and dizziness with a lowering of hemoglobin up to 7.5 gm/dl. The blood transfusion was done to raise the hemoglobin. The upper gastrointestinal endoscopy revealed a giant submucosal polypoidal mass with a thick short stalk in duodenal bulb causing almost complete obstruction of the lumen of duodenum and there was a superficial ulceration on the under-surface of the mass. The endoscopic ultrasound revealed a submucosal lesion arising from the echo layer three. The computed tomography of abdomen showed that the polypoidal mass was confined to the duodenal lumen with no significant lumphadenopathy and normal biliary and pancreas. The endoscopic polypectomy was attempted, but the lesion was too large to grab the polyp as a whole with the conventional snare. Hence, the repeated partial snare polypectomies were done, followed by submucosal dissection to ensure the complete removal of the mass. There were no complications after the procedure. The histopathology examination of the duodenal mass confirmed the diagnosis of Brunner’s gland hamartoma and showed the presence of Helicobacter pylori as well. The endoscopic treatment of giant Brunner’s gland hamartoma avoided the need of unnecessary more invasive surgical procedure.  

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