Duodenal neoplasm in screening esophagogastroduodenoscopy

Background

It is difficult and often impossible to screen the whole duodenum with esophagogastroduodenoscopy (EGD) technically. It seems sufficient for most of the EGD screening programs to search around the first and the second portions of the duodenum including duodenal papilla for duodenal neoplasms because other duodenal portions are believed to have rarely neoplastic lesions.

Methods

The data of the EGD screening program from June 2012 through April 2016 at Ota Memorial Hospital (OMH) in Japan was reviewed. All duodenal neoplasms detected in the EGD screening program were analyzed to reveal their characteristics.

Results

17,449 individuals were enrolled in EGD screening program of OMH during the above period. Thirteen cases had neoplastic lesions in their duodenum (0.07%). Four of them were malignant lesions those included one duodenal carcinoma, one cancer of duodenal papilla, and two malignant lymphomas. All other nine neoplasms were adenoma. The first, the second, and the third portions of duodenum had one (7.7%), seven (53.8%), and five lesions (38.5%) respectively. A duodenal cancer located at the third portion of the duodenum. Ten cases were categorized as the superficial non-ampullary duodenal epithelial tumor (SNADET). Five of them (50%) located at the third portion of duodenum. The second and the first portions had four (40%) and one (10%) respectively. Twelve of all thirteen duodenal neoplasms (92.3%) were detected during the second half of this study period. The detection rate of the duodenal neoplasm in the second half term was 0.13% whereas that was 0.01% in the first half term.

Conclusions

38.5% of duodenal neoplasms were found at the third portion where usual EGD screening rarely approaches. 50% of SNADETs those include one case of carcinoma were recognized at the third portion. The detection rate of duodenal neoplasm in EGD screening program of OMH increases recently because of technical and technological improvement of endoscopy probably. It is important for EGD screening to include the duodenal third portion carefully if possible.

Clinical trial identification

Legal entity responsible for the study

Retrospective study of one private screening center

Funding

Ota Memorial Hospital

Disclosure

All authors have declared no conflicts of interest.