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. 2022 Jul 27:2022:1381299.
doi: 10.1155/2022/1381299. eCollection 2022.

Efficacy and Safety of Exploring Deeper Sections of the Infrapapillary Area of the Duodenum by Using Sedative Esophagogastroduodenoscopy

Ming-Tse Hsu  1 , Chi-Yi Chen  1 , Kai-Sheng Liao  2 , Wei-Sheng Chung  3   4   5
Affiliations

Efficacy and Safety of Exploring Deeper Sections of the Infrapapillary Area of the Duodenum by Using Sedative Esophagogastroduodenoscopy

Ming-Tse Hsu et al. Gastroenterol Res Pract. .

Abstract

Background: Using conventional esophagogastroduodenoscopy (EGD) to evaluate the infrapapillary area is not feasible. The use of sedative EGD may enable endoscopists to investigate the infrapapillary condition of the duodenum. In this study, we aimed to evaluate lesions in the infrapapillary regions by using sedative EGD.

Methods: In this retrospective observational study, we used the data of patients who underwent sedative EGD examinations at a tertiary hospital in southern Taiwan. The endoscopists evaluated the esophagus, stomach, and proximal duodenum and then attempted to explore the infrapapillary portion of the duodenum as deeply as possible. We assessed the success rate for the exploration of infrapapillary areas. Furthermore, we analyzed specific clinical findings of sedative EGD examination.

Results: In total, 2973 patients underwent sedative EGD between November 1, 2010, and December 31, 2011. For 2632 of these patients, it was their first sedative EGD examination. In 2511 patients (95.4%), the exploration of the infrapapillary areas was successful. In approximately 10% of the patients, specific findings were detected over the infrapapillary region, and 7 of these patients exhibited clinically significant findings (i.e., gallbladder cancer with metastasis, periampullary Vater adenoma, natural killer cell enteropathy, villous adenoma with moderate dysplasia, infrapapillary duodenal adenoma with dysplasia, duodenal perforation with tumor-like formation, and follicular lymphoma). No patient experienced minor or major adverse reactions during the sedative EGD procedure.

Conclusions: The current study provided evidence that sedative EGD examination enables a safe, comfortable, and effective endoscopic examination of deeper sections of the duodenum to evaluate the papillary and infrapapillary regions.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
(a) Small polypoid lesions with shallow ulcers over the infrapapillary area (arrow). (b) Duodenal involvement of adenocarcinoma, featuring neoplastic epithelial cells arranged in irregular glands infiltrating the stroma (H&E, 100x).
Figure 2
Figure 2
(a) Flat periampullary Vater tumor (arrow). (b) Duodenal tubular adenoma with mild dysplasia composed of dysplastic glandular cells with low-grade dysplasia in tubular architecture (H&E, 100x).
Figure 3
Figure 3
(a) Shallow ulcer over the infrapapillary area (arrow). (b) NK cell enteropathy composed of mononuclear cells infiltrating the duodenal mucosa. Further immunohistochemical staining confirmed the NK cell phenotype (CD3+/CD56+/TIA-1+) (H&E, 100x).
Figure 4
Figure 4
(a) Flat polyp over the infrapapillary area (arrow). (b) Duodenal villous adenoma with moderate dysplasia composed of dysplastic glandular cells with low-grade dysplasia in villous architecture (H&E, 100x).
Figure 5
Figure 5
(a) Ulcerated lesion over the infrapapillary area (arrow). (b) Mucosal glands of the duodenum with focal low-grade dysplasia (arrow) (H&E, 100x).
Figure 6
Figure 6
(a) Collapsed lumen with ulcerated mass obstruction over the infrapapillary area (arrow). (b) Transmural fistular tract (arrow) in the third portion of the duodenum with perforation and inflammation (H&E, 40x).
Figure 7
Figure 7
(a) White patches and nodules over the infrapapillary area (arrow). (b) Duodenal follicular lymphoma (arrow), featuring multiple lymphoid follicles in the lamina propria, composed of relatively uniform small lymphoid cells. Further immunohistochemical staining confirmed follicular lymphoma (CD20+/BCL2+/BCL6+/CD10+) (H&E, 100x).
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