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de Bakker JK, Meijer LL, Zonderhuis BM, van der Vliet HJ, Daams F, van Grieken NCT, Lissenberg-Witte BI, Kazemier G. Adjuvant chemotherapy for resected duodenal adenocarcinoma: a case-matched analysis in nation wide cohort. Acta Chir Belg 2023; 123:502-508. [PMID: 35727126 DOI: 10.1080/00015458.2022.2092961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/17/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Duodenal adenocarcinoma (DA) is a rare tumor for which survival data on adjuvant chemotherapy in patients after surgical treatment are unclear. This case-matched study in a nationwide cohort aims to investigate the benefit of adjuvant chemotherapy for patients with resectable DA on overall survival. METHODS All patients diagnosed with DA and intestinal type periampullary adenocarcinoma (PVA) in the Netherlands between 2000 and 2015 were included (n = 1316). Patients with disease stages II and III who underwent resection and adjuvant chemotherapy were matched (1:2), based on identified covariates associated with OS, with patients who underwent surgery alone. Overall survival was compared using Kaplan-Meier estimates. RESULTS The median OS was 49.9 months in patients who underwent curative resection (n = 649). Univariate and multivariate analysis showed a significant influence of age, lymph node involvement, and T- stage on survival. The group of patients receiving adjuvant treatment consisted of 43 patients and the non-adjuvant group of 83 case-matched patients. The median OS of the complete matched cohort (n = 126) was 26.9 months. No statistically significant survival benefit was found for the adjuvant group as compared to the group treated with surgery alone (median OS = 34.4 months and 23.0 months, p = 0.20). CONCLUSION This population-based, case-matched analysis demonstrates no statistically significant survival benefit for adjuvant chemotherapy after curative resection in stages II and III patients. Future studies with specified treatment regimens as well as thorough stratification for prognostic factors will be required in order to more definitively determine the role of adjuvant therapy.
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Affiliation(s)
- J K de Bakker
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - L L Meijer
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - B M Zonderhuis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - H J van der Vliet
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - F Daams
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - N C T van Grieken
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - B I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - G Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
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Lum Min SA, Imam M, Zrinyi A, Shawyer AC, Keijzer R. Post-discharge follow-up of congenital duodenal obstruction patients: a systematic review. Pediatr Surg Int 2023; 39:239. [PMID: 37490166 DOI: 10.1007/s00383-023-05515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Long-term follow-up of congenital duodenal obstruction patients often falls on care providers with little experience of this condition. We performed a systematic review of the long-term outcomes of duodenal obstruction and provide a summary of sequelae care providers should anticipate. METHODS In 2022, after registering with PROSPERA, Medline (Ovid), EMBASE, PSYCHINFO, CNAHL and SCOPUS databases were searched using the title keyword 'intestinal atresia'. Abstracts were filtered for inclusion if they included the duodenum. Papers of filtered abstracts were included if they reported post-discharge outcomes. Methodological Index for Non-Randomized Studies was used to grade the papers. RESULTS Of the 1068 abstracts were screened, 32 papers were reviewed. Eleven studies were included. Thirty additional papers were included after reviewing references, for a total of 41 papers. The average MINORS was 7/16. CONCLUSION There is good evidence that children with congenital duodenal obstruction do well in terms of survival, growth and general well-being. Associated cardiac, musculoskeletal and renal anomalies should be ruled-out. Care providers should be aware of anastomotic dysfunction, blind loop syndrome, bowel obstruction and reflux. Reflux may be asymptomatic. Laparoscopic repair does not change long-term outcomes, and associated Trisomy 21 worsens neurodevelopmental outcomes.
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Affiliation(s)
- Suyin A Lum Min
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Malaz Imam
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Anna Zrinyi
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Anna C Shawyer
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Richard Keijzer
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada.
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3
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Liu Z, Gao J, Wang P, Yin F, Zeng C, Chen Y. Comparable long-term survival outcomes of endoscopic therapy versus surgical therapy for T1-2N0M0 duodenal neuroendocrine tumors. Surg Endosc 2023; 37:5444-5452. [PMID: 37036503 DOI: 10.1007/s00464-023-10019-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/12/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND AND STUDY AIMS The optimal treatment modality for T1-2N0M0 duodenal neuroendocrine tumors (DNETs) is still controversial. In this study, long-term survival outcomes were compared between the endoscopic therapy and surgical therapy for T1-2N0M0 DNETs using the Surveillance, Epidemiology, and End Results (SEER) database. PATIENTS AND METHODS Patients with DNETs from the SEER database were selected from 2004 to 2015. We used the Kaplan-Meier method and log-rank test to compare long-term survival results between the endoscopic therapy and surgical therapy. An analysis of the multivariable Cox proportional hazards model was performed to identify risk factors for patient prognoses. The 1:1 propensity score matching (PSM) was performed to balance baseline data. RESULTS A total of 816 patients with DNETs were included, of which 578 patients (70.8%) received endoscopic therapy and 238 patients (29.2%) received surgical therapy. Before the PSM, there was no difference between the two groups of patients with DNETs on long-term survival [5-year OS (86.1% vs. 87.9%, P = 0.45), 10-year OS (72.5% vs. 72.3%, P = 0.45)]. After adjusting covariates, we found endoscopic therapy and surgical therapy groups had comparable risks of overall survival (HR 0.86, 95% CI 0.60-1.23, P = 0.409) and cancer-specific survival (HR 1.68, 95% CI 0.74-3.83, P = 0.214). In the post-PSM analysis, there was no discernible difference between the endoscopic therapy and surgical therapy group. CONCLUSIONS Our study found that for T1-2N0M0 DNETs patients, whose long-term OS and CSS results were similar for the endoscopic and surgical therapy groups. For these patients, endoscopic resection might be an optimal therapy modality.
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Affiliation(s)
- Zide Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Jiaxin Gao
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Peng Wang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Fang Yin
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Chunyan Zeng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
- Jiangxi Provincial Key Laboratory of Interdisciplinary Science, Nanchang University, Nanchang, 330006, Jiangxi, China.
| | - Youxiang Chen
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
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Tu Y, Chu S, Huang Z. Duodenal ganglion cell paraganglioma: A case report. Asian J Surg 2023; 46:1244-5. [PMID: 36028405 DOI: 10.1016/j.asjsur.2022.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
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Yan H, Liu X, Yin L, Han H, Jin Y, Zhu X, Liu Z. Effects of endoscopic therapy and surgical resection on long-term survival outcomes in patients with duodenal gastrointestinal stromal tumors: a surveillance, epidemiology, and end result program analysis. Surg Endosc 2022; 36:8030-8038. [PMID: 35437643 DOI: 10.1007/s00464-022-09231-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND With the rapid development of endoscopic technology, endoscopic therapy (ET) has gradually become a new treatment choice for gastrointestinal stromal tumors (GISTs). However, due to the low incidence of duodenal GIST and the difficulty of ET, there is a lack of data to compare the long-term results of ET and surgical resection. METHODS Duodenal GIST patients from 2004 to 2015 were selected from the surveillance, epidemiology, and end result (SEER) database. We used the Kaplan-Meier method and log-rank test to describe the 5- and 10-year survival differences between the ET and the surgery groups. The multivariate Cox proportional hazard model was used for analyzing the risk factors influencing the prognosis of patients. We used a 1:1 propensity score-matched (PSM) to reduce confounding factors, and then we compared survival differences between the two groups again. RESULTS A total of 294 patients with duodenal GIST were enrolled, including 41 (13.9%) patients with ET and 253 (86.1%) patients with surgical resection. Before PSM, the long-term survival of patients with duodenal GIST after ET and surgical resection was similar [5-year overall survival (OS) (79.7 vs. 79.3%, p = 0.876), 10-year OS (66.5 vs. 68.1%, p = 0.876)]. After adjusting the relevant variables using multivariate Cox analysis, we found that the ET and surgery groups were comparable in OS and cancer-specific survival (CSS). After PSM, there was also no significant difference between ET and surgical resection for long-term OS and CSS. CONCLUSION Our study found no significant difference in long-term survival between ET and surgical resection in patients with duodenal GIST. However, to obtain high-quality evidence, more extensive sample size studies are needed in the future to evaluate the long-term effects of ET on patients.
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Affiliation(s)
- Haihao Yan
- Medical Center for Digestive Diseases, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Xiang Liu
- Medical Center for Digestive Diseases, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Linlin Yin
- Medical Center for Digestive Diseases, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Hao Han
- Medical Center for Digestive Diseases, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Ye Jin
- Medical Center for Digestive Diseases, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Xiaojuan Zhu
- Medical Center for Digestive Diseases, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China
| | - Zheng Liu
- Medical Center for Digestive Diseases, Second Affiliated Hospital, Nanjing Medical University, Nanjing, 210011, Jiangsu, China.
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Ye N, Bao X, Zhao X, Wang B. Signet-ring cell carcinoma of the duodenal bulb presenting with gastrointestinal hemorrhage: a case report and literature review. BMC Gastroenterol 2022; 22:226. [PMID: 35534806 PMCID: PMC9087945 DOI: 10.1186/s12876-022-02267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Primary duodenal cancer (PDC) is rare, especially signet-ring cell carcinoma (SRCC) of the duodenal bulb, and it is commonly misdiagnosed as an ulceration. Here, we report a rare case of SRCC of the duodenal bulb presenting with gastrointestinal hemorrhage in an 82-year-old man. Case presentation An 82-year-old man was admitted for gastrointestinal hemorrhage. Physical examination revealed upper abdominal tenderness and pale appearance, but was otherwise unrevealing. Laboratory workup was significant for anemia. Imaging showed no abnormalities. Two endoscopic evaluations along with interventional embolization were attempted and, unfortunately, adequate hemostasis was not achieved, resulting in distal subtotal gastrectomy, including the duodenal bulb. SRCC of the duodenal bulb was diagnosed based on pathology after surgery. Post-operatively, the patient experienced persistent gastrointestinal bleeding. Family declined further intervention and the patient eventually died one month post-resection. Conclusions SRCC in the duodenal bulb is difficult to diagnose. For those with high-risk factors, endoscopic examination and biopsy are recommended. For patients who can receive radical tumor resection, pancreaticoduodenectomy (PD) is considered a first-line option. Early diagnosis and resection have been shown to improve prognosis.
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Affiliation(s)
- Nan Ye
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, Zhejiang Province, Jinhua, 322100, China
| | - Xiaoxiao Bao
- Department of Pathology, Dongyang People's Hospital, Zhejiang Province, Jinhua, 322100, China
| | - Xiaokang Zhao
- Department of Gastrointestinal Surgery, Dongyang People's Hospital, Zhejiang Province, Jinhua, 322100, China
| | - Bin Wang
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, Zhejiang Province, Jinhua, 322100, China.
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7
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Nabi Z, Ramchandani M, Asif S, Basha J, Chavan R, Darisetty S, Reddy N. Outcomes of Endoscopic Submucosal Dissection in Duodenal Neuroendocrine Tumors. J Gastrointest Surg 2022; 26:275-277. [PMID: 34508292 DOI: 10.1007/s11605-021-05133-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/21/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIM Endoscopic resection is recommended for small duodenal neuroendocrine tumors DNETs. However, there is limited data on the outcomes of endoscopic submucosal dissection (ESD) in DNETs. In this study, we aimed to evaluate the outcomes of ESD in DNETs. METHODS Data of consecutive patients who underwent ESD for DNETs from January 2018 to December 2019 were analyzed, retrospectively. All the cases of ESD were performed with or without traction using rubber band and two endoclips. En-bloc resection, complete endoscopic resection (C-ER), complete pathological resection (C-PR), adverse events, and recurrence were evaluated. RESULTS Twenty patients (19 males, 57.50 ± 9.32 years) underwent ESD for DNETs. DNETs measured ≤ 10 mm (7), 10-15 mm (12), and > 15 mm (1). ESD was performed with and without traction in 10 cases each. Mean operating time was 61 ± 17.38 min. En-bloc resection, C-ER, and C-PR were recorded in 90%, 95%, and 75%, respectively. Vertical margins were positive in five patients. Adverse events included perforations in 4 (20%) cases and major bleeding in one case. There was no recurrence at a mean follow-up of 17.20 ± 7.37 months. CONCLUSION ESD is feasible and effective for the management of DNETs. However, caution is advised due to a high risk of adverse events and pathologically incomplete resection.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, 6-3-661, Somajiguda, Hyderabad, 500 082, India.
| | - Mohan Ramchandani
- Asian Institute of Gastroenterology, Hyderabad, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Shujaath Asif
- Asian Institute of Gastroenterology, Hyderabad, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Jahangeer Basha
- Asian Institute of Gastroenterology, Hyderabad, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Radhika Chavan
- Asian Institute of Gastroenterology, Hyderabad, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Santosh Darisetty
- Asian Institute of Gastroenterology, Hyderabad, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Nageshwar Reddy
- Asian Institute of Gastroenterology, Hyderabad, 6-3-661, Somajiguda, Hyderabad, 500 082, India
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Khan H, Connolly T, Loh MY, Clark E. Duodenal volvulus: a rare cause of small bowel obstruction. Ann R Coll Surg Engl 2021; 104:e102-e104. [PMID: 34846192 DOI: 10.1308/rcsann.2021.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Small bowel volvulus is a rare but life-threatening emergency. Volvulus of the duodenum is even rarer without the presence of predisposing factors. The clinical presentation is vague, including abdominal pain, nausea and vomiting, prompt diagnosis of volvulus therefore relies heavily on radiographs. The treatment options lie between conservative or surgical management, where the decision is influenced by the patient and their presentation. This case is of a 100-year-old female with an extensive surgical and medical background presenting with signs of small bowel obstruction. With the help of imaging, a rare case of duodenal volvulus was diagnosed but managed conservatively due to the patient's background, age and personal wishes.
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Affiliation(s)
- H Khan
- Stockport NHS Foundation Trust, UK
| | | | - M-Y Loh
- Stockport NHS Foundation Trust, UK
| | - E Clark
- Stockport NHS Foundation Trust, UK
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Pyuza JJ, Shao ER, Bosco K, Lodhia J, Mremi A. An incidental finding of duodenal GIST in a patient with penetrating abdominal trauma: A case report. Int J Surg Case Rep 2021; 85:106263. [PMID: 34388898 PMCID: PMC8350535 DOI: 10.1016/j.ijscr.2021.106263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Duodenal Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the digestive tract. The tumors are derived from interstitial cells of Cajal and usually they present as gastrointestinal bleeding or non-specific abdominal pain, but they can also be asymptomatic even when they have reached considerable size. CASE PRESENTATION We report a case of a 40-year-old male presented to our emergency department after sustaining a stab wound on the abdomen. Abdominal imaging tests weren't done; instead an emergency laparotomy was undertaken upfront in an attempt to catch up with a "golden hour". Intra-operatively, an incidental solid mass measuring 4 × 5 cm was noted on the third/fourth portion of the interior duodenal flexure. Histopathologically, the lesion demonstrated spindled shaped cells which were immunopositive for positive CD117. The patient fared well postoperatively and during subsequent follow up visits. CLINICAL DISCUSSION High-risk GISTs have malignant potential. In some cases, GIST is diagnosed as incidentally finding, mostly during surgical procedure, upper endoscopy or radiological studies related to GI tract. Surgical resection is recommended curative option and its extension depends on different factors. Tyrosine kinase inhibitors are of the utmost importance in high-risk and metastatic disease. CONCLUSION Even considerably large duodenal GISTs can be asymptomatic, thus incidentally found during an abdomino-pelvic imaging tests. Histopathological evaluation of the operative specimen plays a key role in assessing the need of adjuvant therapy, with a significant impact on the patients' survival.
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Affiliation(s)
- Jeremia J Pyuza
- Department of Pathology, Kilimanjaro Christian Medical Centre, P.O.BOX 3010, Moshi, Tanzania
| | - Elichilia R Shao
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P.O, BOX 2240, Moshi, Tanzania; Department of Internal Medicine, Kilimanjaro Christian Medical Center, P.O.BOX 3010, Moshi, Tanzania
| | - Kenan Bosco
- Department of Internal Medicine, Kilimanjaro Christian Medical Center, P.O.BOX 3010, Moshi, Tanzania
| | - Jay Lodhia
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P.O, BOX 2240, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Center, P.O.BOX 3010, Moshi, Tanzania
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, P.O.BOX 3010, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, P.O, BOX 2240, Moshi, Tanzania.
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Wang Z, Du Z, Zhou X, Chen T, Li C. Misdiagnosis of peripheral abscess caused by duodenal foreign body: a case report and literature review. BMC Gastroenterol 2020; 20:236. [PMID: 32703254 PMCID: PMC7376966 DOI: 10.1186/s12876-020-01335-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/05/2020] [Indexed: 12/27/2022] Open
Abstract
Background The induction of chronic inflammation, perforation, and abscess by foreign bodies (FBs) in adults is uncommon. We present a delayed diagnosis case for a patient who had a fishbone stuck in the duodenal bulb, resulting in chronic abdominal pain for nearly 3 months. We present the diagnosis and treatment procedures for chronic patients, which differ from those for acute and emergency FB ingestion, and also summarize the characteristics of such patients through a systematic literature review. Case presentation A 68-year-old woman was brought to our hospital with repeated right upper abdominal pain lasting for 3 months and aggravation for 9 h. Computed tomography (CT) showed a streaky high-density shadow (approximately 3 cm in length) on the posterior wall of the gastric antrum extending outside the wall. Endoscopic ultrasonography showed hyperechoic space with a cross-section of approximately 0.1 × 0.1 cm in the deep submucosal layer of the local stomach, accompanied by an acoustic shadow in the rear. The possibility of a fishbone as well as perforation was considered and the object was removed using FB forceps. Fasting as well as acid inhibition and anti-infection medication were prescribed for the patient. She eventually recovered and was discharged from the hospital. Conclusion Endoscopic intervention can be recommended as the first option for patients with gastrointestinal FBs.
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Affiliation(s)
- Zhihui Wang
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| | - Zhiqiang Du
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China.
| | - Xiangrong Zhou
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| | - Tianming Chen
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| | - Chunyan Li
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
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Amini A, Koury E, Vaezi Z, Melnick J, Su A, Chahla E. Duodenal angiosarcoma can be misdiagnosed as a Dieulafoy's lesion. Gastroenterol Hepatol Bed Bench 2020; 13:268-271. [PMID: 32821359 PMCID: PMC7417484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Angiosarcomas are soft-tissue neoplasms that originate from the vascular epithelium. The most commonly involved sites include the skin and subcutaneous tissues. In the GI tract, generally, angiosarcomas involve the spleen and liver, although locations in the small intestine and colon have been very occasionally reported. In the present study we report the unusual case of a man with duodenal epithelioid angiosarcoma, presenting with anemia and recurrent upper gastrointestinal bleeding, which was initially misdiagnosed as a Dieulafoy's lesion. It is important to consider the diagnosis of gastrointestinal malignancy, including unusual neoplasms such as angiosarcomas, in the setting of anendoscopic appearance such as hemorrhagic nodule, purpuric mass and/or recurrent bleeding lesions that are persistent despite repeat interventions. In such cases, a biopsy should be considered to confirm the diagnosis.
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Affiliation(s)
- Afshin Amini
- Department of Medicine, St. Luke’s Hospital, Chesterfield, MO, USA
| | - Elliot Koury
- Department of Medicine, St. Luke’s Hospital, Chesterfield, MO, USA
| | - Zahra Vaezi
- Department of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Jeffrey Melnick
- Department of Pathology, St. Luke’s Hospital, Chesterfield, MO, USA
| | - Andrew Su
- Division of Gastroenterology and Hepatology, Department of Medicine, St. Luke’s Hospital, Chesterfield, MO, USA
| | - Elie Chahla
- Department of Medicine, St. Luke’s Hospital, Chesterfield, MO, USA,Division of Gastroenterology and Hepatology, Department of Medicine, St. Luke’s Hospital, Chesterfield, MO, USA
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12
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Du C, Liu J, Wan H, Dong H, Zhao X. Functional Role of Basolateral ClC-2 Channels in the Regulation of Duodenal Anion Secretion in Mice. Dig Dis Sci 2019; 64:2527-2537. [PMID: 30874987 DOI: 10.1007/s10620-019-05578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/05/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Although ClC-2 channels are important in colonic Cl- secretion, it is unclear about their roles in small intestinal anion secretion. Therefore, we sought to examine whether ClC-2 channels play important roles in anion secretion, particularly duodenal bicarbonate secretion (DBS). METHODS Duodenal mucosae from mice were stripped of seromuscular layers and mounted in Ussing chambers. Both duodenal short-circuit current (Isc) and HCO3- secretion in vitro were simultaneously recorded. DBS in vivo was measured by a CO2-sensitive electrode. RESULTS Lubiprostone, a selective ClC-2 activator, concentration-dependently increased both duodenal Isc and DBS only when applied basolaterally, but not when applied apically. Removal of extracellular Cl- abolished lubiprostone-induced duodenal Isc, but did not alter HCO3- secretion even in the presence of DIDS, a Cl-/HCO3- exchanger inhibitor. However, further addition of glibenclamide, a CFTR channel blocker, abolished lubiprostone-evoked HCO3- secretion. Moreover, lubiprostone-induced HCO3- secretion was impaired in CFTR-/- mice compared to wild-type littermates. Luminal perfusion of duodenal lumen with lubiprostone did not alter basal DBS in vivo, but lubiprostone (i.p.) was able to induce DBS, which was also significantly inhibited by Cd2+, a ClC-2 channel blocker. [Ca2+]cyt level, Ca2+-activated K+ channel- and cAMP-mediated duodenal Isc, and HCO3- secretion were unchanged by lubiprostone. CONCLUSIONS We have provided the first evidence for the novel functional role of basolateral ClC-2 channels in the regulation of duodenal anion secretion.
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Affiliation(s)
- Chao Du
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Jingjing Liu
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Hanxing Wan
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Hui Dong
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China. .,Department of Medicine, School of Medicine, University of California, San Diego, CA, 92093, USA.
| | - Xiaoyan Zhao
- Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
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Abstract
PURPOSE OF REVIEW Obesity is increasing at an alarming rate and now poses a global threat to humankind. In recent years, we have seen the emergence of medical devices to combat the obesity epidemic. These therapeutic strategies are discussed in this review dividing them into gastric and duodenal therapies. RECENT FINDINGS Traditionally, medical devices for obesity such as the intragastric balloon have focused on reducing gastric size, but more recently there has been a shift towards developing devices that modulate neural and hormonal responses to induce early satiety thus reducing oral intake. Medical devices for obesity treatment may have a role in those patients who are struggling to control their weight despite significant lifestyle modifications such as diet and exercise and who decline or are unfit for bariatric surgery. For the wider adoption and integration of these devices in the obesity treatment paradigm, more long-term efficacy and safety data from randomised controlled trials are required.
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Affiliation(s)
- Aruchuna Ruban
- Imperial College London, St Mary’s Campus, London, W2 1NY UK
| | - Akash Doshi
- Department of Surgery & Cancer, Homerton University Hospital, London, E9 6SR UK
| | - Erika Lam
- Department of Surgery & Cancer, Homerton University Hospital, London, E9 6SR UK
| | - Julian P. Teare
- Imperial College London, St Mary’s Campus, London, W2 1NY UK
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14
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Stavrou G, Rafailidis V, Diamantidou A, Kouskouras C, Michalopoulos A, Kotzampassi K. Successful closure of a complicated duodenal ulcer perforation with an expandable esophageal stent. Asian J Endosc Surg 2019; 12:326-328. [PMID: 30141274 DOI: 10.1111/ases.12642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/17/2018] [Accepted: 07/22/2018] [Indexed: 11/26/2022]
Abstract
Laparotomy and reoperation remain the standard procedures for patients with suture line disruption after the initial surgical treatment for duodenal ulcer perforation has failed. Recently, endoscopic stents have been employed for dehiscence of the suture line after a surgical repair or even as a primary treatment. We present such a case, the fourth in the literature. In this case, a partially covered stent was placed to cover the duodenal perforation opening after an unsuccessful stitching 6 days earlier. We discuss the difficulties in stent positioning, the choice of sealant, and possible complications. Overall, for older patients with comorbidities, endoscopic stent placement could be considered a promising alternative minimally invasive treatment.
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Affiliation(s)
- George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Vasileios Rafailidis
- Department of Radiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Anna Diamantidou
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Constantinos Kouskouras
- Department of Radiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Antonios Michalopoulos
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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15
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Deng X, Fang R, Zhang J, Li R. Multivisceral IgG4-related disease presenting as recurrent massive gastrointestinal bleeding: a case report and literature review. BMC Gastroenterol 2018; 18:136. [PMID: 30180812 PMCID: PMC6123933 DOI: 10.1186/s12876-018-0867-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/29/2018] [Indexed: 02/05/2023] Open
Abstract
Background IgG4-related disease (IgG4-RD) is a newly recognized autoimmune systemic disorder characterized by elevated levels of serum IgG4 and abundant infiltration of IgG4-positive plasmacytes in the affected organs. The liver, biliary system and pancreas are the most commonly affected organs. However, involvement of the digestive tract is very rare. To date, only a few cases of isolated gastric IgG4-RD have been reported. Case presentation We present a case of IgG4-RD of the liver, gallbladder, pancreas and duodenum, which was clinically misinterpreted and thereafter over-treated. A 52-year-old male presented with obstructive jaundice for 3 years, melena for 5 months and hematemesis for 10 days. Three years prior, the patient had undergone biopsies of pancreatic lesions, liver lesions, cholecystectomy and choledochojejunostomy. Histopathology showed chronic inflammatory changes. Endoscopy at admission revealed a duodenal ulcer with active bleeding. Despite medical management, the patient presented with repeated gastrointestinal bleeding. Upon evaluation, serum IgG4 levels were found to be elevated. Histopathology of the duodenal ulcer biopsy and repeated examination of the gallbladder and pancreatic and liver biopsies confirmed IgG4 positive plasma cell infiltration. A definitive diagnosis of IgG4-RD was made and steroid administration was initiated. At last follow up, 11 months to-the-day after initiating steroid treatment, the patient was asymptomatic. Conclusions Notably, IgG4-RD of multiple digestive organs is still very rare. As a systemic disease, it is characterized by the infiltration of IgG4-bearing plasma cells and raised IgG4 levels. Histopathology findings remain the diagnostic gold standard for this disorder.
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Affiliation(s)
- Xuexue Deng
- Department of General Medicine, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Wuhou District, Chengdu City, Sichuan Province, China
| | - Ronghua Fang
- Department of General Medicine, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Wuhou District, Chengdu City, Sichuan Province, China.
| | - Jianshu Zhang
- Department of General Medicine, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Wuhou District, Chengdu City, Sichuan Province, China
| | - Rongqiong Li
- Department of General Medicine, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Wuhou District, Chengdu City, Sichuan Province, China
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16
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Dasari BVM, Al-Shakhshir S, Pawlik TM, Shah T, Marudanayagam R, Sutcliffe RP, Mirza DF, Muiesan P, Roberts KJ, Isaac J. Outcomes of Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumours (NETs): a Systematic Review of the Literature. J Gastrointest Surg 2018; 22:1652-8. [PMID: 29869091 DOI: 10.1007/s11605-018-3825-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/17/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Duodenal neuroendocrine tumours (dNETs) comprise about 2% of all the NETs. Treatment of dNETs involves resection of the tumour either by endoscopic or surgical resection. Surgical or endoscopic local resection of the lesion is usually a more conservative and less morbid option compared with a more radical pancreaticoduodenectomy. However, inadequate clearance by local resection might result in recurrent disease with reduced overall survival. METHODS The current systematic review compared the differences in outcomes of endoscopic resection (ER), local resection (LR) and pancreaticoduodenectomy (PD) in the management of dNETs. Searches were performed on MEDLINE, PubMed, Embase and Cochrane databases using MeSH keyword combinations: 'duodenal', AND, 'neuroendocrine tumours'. All relevant articles published up to 2016 were included. Post-operative morbidity, R0 resection status and recurrence rates were the outcomes assessed. RESULTS Eight non-randomised retrospective studies with 335 participants were included (LR = 122; PD = 118; ER = 64). While PD was associated with higher morbidity compared with LR (27/64 vs. 10/74; P = 0.002), PD was associated with a higher incidence of an R0 resection (3/97 vs. 15/97; P = 0.007) as well as lower recurrence rates (3/51 vs. 6/46; P = 0.21). ER was associated with a higher positive resection margin status versus LR (22/51 vs. 14/91; P = 0.0002). Recurrence at follow-up was not different among patients with dNETs who underwent PD versus LR. CONCLUSIONS Radical surgical resection in the form of PD was associated with higher post-operative morbidity among patients with dNETs yet provided better margin clearance. Patients with dNETs need systematic evaluation with a view to obtain most of the information about the prognostic factors in order to tailor the treatment options.
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17
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Ali WM, Ansari MM, Rizvi SAA, Rabb AZ, Mansoor T, Harris SH, Akhtar MS. Ten-Year Experience of Managing Giant Duodenal Ulcer Perforations with Triple Tube Ostomy at Tertiary Hospital of North India. Indian J Surg 2018; 80:9-13. [PMID: 29581678 DOI: 10.1007/s12262-016-1538-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 08/08/2016] [Indexed: 11/28/2022] Open
Abstract
Duodenal ulcer perforations have been known since 1600 AD. It is a common surgical emergency and every surgeon will encounter it. The perforation size of >2 cm has been used as the criteria for defining Giant duodenal ulcers. The management of giant duodenal perforations in hemodynamically unstable patient with comorbid condition is taxing because of high incidence of the postoperative leak and mortality. We have used the simple technique of Triple Tube Ostomy after the primary closure of the defect with encouraging results. It is a retrospective study done at the J. N medical college AMU Aligarh from May 2005 to May 2015. Hemodynamically unstable patients who have presented to the emergency with preoperative diagnoses of giant duodenal ulcer perforation and had undergone triple tube ostomy with primary repair of the perforation were included in the study. There were 34 patients of giant duodenal perforation who presented in shock. All of them underwent triple-tube-ostomy after primary repair of the duodenum. Thirty-two patients recovered with two mortalities (5.8 %). Several definite surgical techniques have been described for the management of giant duodenal ulcer perforation but they are complex, have very high morbidity and mortality rate and require an expert surgeon. A close retrospective scrutiny of the patients suggests that simple triple-tube-ostomy technique which is based on the principle of damage control surgery has good postoperative results Therefore, we recommend it as the procedure of choice in these patients.
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Affiliation(s)
| | - M M Ansari
- Department Of Surgery, J. N Medical College, AMU, Aligarh, India
| | | | - A Z Rabb
- Department Of Surgery, J. N Medical College, AMU, Aligarh, India
| | - Tariq Mansoor
- Department Of Surgery, J. N Medical College, AMU, Aligarh, India
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18
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Abstract
Upper gastrointestinal neuroendocrine tumors (NETs) are rare tumors which are increasingly recognised by practising endoscopists. After confirmation by endoscopic biopsies of these focal lesions, many questions may arise. As NETs are less frequently encountered compared to other malignancies or gastrointestinal pathology, many endoscopists may not fully understand the natural history, diagnosis and management of these tumors. In this review, we aim to update the practising endoscopist on the key clinical features and management of patients with upper gastrointestinal NET.
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Affiliation(s)
- Jun Liong Chin
- Department of Gastroenterology, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Dermot O'Toole
- Department of Gastroenterology, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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19
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Murray L, Haley C, Berry-Cabán CS, Toledo A. Duodenal neuroendocrine tumor and the onset of severe diabetes mellitus in a US veteran. SAGE Open Med Case Rep 2016; 4:2050313X15624530. [PMID: 27489708 PMCID: PMC4927219 DOI: 10.1177/2050313x15624530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/19/2015] [Indexed: 01/09/2023] Open
Abstract
Objective: Neuroendocrine tumors are neoplasms derived from endocrine cells, most commonly occurring in the gastrointestinal tract. Duodenal neuroendocrine tumors are rare tumors averaging 1.2–1.5 cm, and most are asymptomatic. Common presentation is abdominal pain, upper gastrointestinal bleed, constipation, anemia, and jaundice. Methods: An adult, Black, male patient with newly diagnosed diabetes mellitus presented to the emergency department with elevated liver function test and fatigue. Results: Magnetic resonance cholangiopancreatography demonstrated a large obstructing mass (3.6 cm × 4.4 cm × 3 cm) within the second and third portions of the duodenum at the ampulla. Esophagogastroduodenoscopy demonstrated an ulcerated duodenal mass that was biopsied. Immunohistochemical stains were positive for synaptophysin, chromogranin B, and CK7. Chromogranin A was in normal range. Post-Whipple procedure demonstrated a 5.5 cm × 4.1 cm × 2.9 cm duodenal mass with invasion of the subserosal tissue of the small intestine, a mitotic rate of 2 per high-power field, and antigen Ki-67 of 2%–5%. Conclusion: This case raises the question as to if the patient developed diabetes mellitus due to the tumor size and location or if the new onset of diabetes was coincidental. This case also demonstrates the importance of a proficient history and physical.
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Affiliation(s)
- Lauren Murray
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
| | - Chelsey Haley
- Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, NC, USA
| | | | - Almond Toledo
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
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20
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Abstract
Organ culture is a valuable technique in celiac disease research. It provides the opportunity to examine interactions between different cell types during the disease process without the need for invasive in vivo studies. Biopsies are maintained in an oxygen-rich environment, in contact with, but not submerged in, culture medium. A very straightforward and successful method of organ culture is described here.
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Affiliation(s)
- Sarah E J Cooper
- Immunology Department, Trinity College Dublin, College Green, Dublin 2, Ireland.
| | - Sharon Wilson
- Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Conleth F Feighery
- Immunology Department, Trinity College Dublin, College Green, Dublin 2, Ireland. .,Immunology Department, St James Hospital, Dublin, Ireland.
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21
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Levenstein S, Rosenstock S, Jacobsen RK, Jorgensen T. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol 2015; 13:498-506.e1. [PMID: 25111233 DOI: 10.1016/j.cgh.2014.07.052] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is controversy over whether psychological stress contributes to development of peptic ulcers. We collected data on features of life stress and ulcer risk factors from a defined population in Denmark and compared these with findings of confirmed ulcers during the next 11-12 years. METHODS We collected blood samples and psychological, social, behavioral, and medical data in 1982-1983 from a population-based sample of 3379 Danish adults without a history of ulcer participating in the World Health Organization's MONICA study. A 0- to 10-point stress index scale was used to measure stress on the basis of concrete life stressors and perceived distress. Surviving eligible participants were reinterviewed in 1987-1988 (n = 2809) and 1993-1994 (n = 2410). Ulcer was diagnosed only for patients with a distinct breach in the mucosa. All diagnoses were confirmed by review of radiologic and endoscopic reports. Additional cases of ulcer were detected in a search of all 3379 subjects in the Danish National Patient Register. RESULTS Seventy-six subjects were diagnosed with ulcer. On the basis of the stress index scale, ulcer incidence was significantly higher among subjects in the highest tertile of stress scores (3.5%) than the lowest tertile (1.6%) (adjusted odds ratio, 2.2; 95% confidence interval [CI], 1.2-3.9; P < .01). The per-point odds ratio for the stress index (1.19; 95% CI, 1.09-1.31; P < .001) was unaffected after adjusting for the presence of immunoglobulin G antibodies against Helicobacter pylori in stored sera, alcohol consumption, or sleep duration but lower after adjusting for socioeconomic status (1.17; 95% CI, 1.07-1.29; P < .001) and still lower after further adjustments for smoking, use of nonsteroidal anti-inflammatory drugs, and lack of exercise (1.11; 95% CI, 1.01-1.23; P = .04). The risk for ulcer related to stress was similar among subjects who were H pylori seropositive, those who were H pylori seronegative, and those exposed to neither H pylori nor nonsteroidal anti-inflammatory drugs. On multivariable analysis, stress, socioeconomic status, smoking, H pylori infection, and use of nonsteroidal anti-inflammatory drugs were independent predictors of ulcer. CONCLUSIONS In a prospective study of a population-based Danish cohort, psychological stress increased the incidence of peptic ulcer, in part by influencing health risk behaviors. Stress had similar effects on ulcers associated with H pylori infection and those unrelated to either H pylori or use of nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
| | - Steffen Rosenstock
- Gastroenterology Department, Surgical Section, Hvidovre University Hospital, Hvidovre, Denmark
| | - Rikke Kart Jacobsen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
| | - Torben Jorgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
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22
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Yu DW, Hong MY, Hong SG. Endoscopic treatment of duodenal fistula after incomplete closure of ERCP-related duodenal perforation. World J Gastrointest Endosc 2014; 6:260-265. [PMID: 24932379 PMCID: PMC4055996 DOI: 10.4253/wjge.v6.i6.260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 03/31/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic modality for various pancreatic and biliary diseases. The most common ERCP-induced complication is pancreatitis, whereas hemorrhage, cholangitis, and perforation occur less frequently. Early recognition and prompt treatment of these complications may minimize the morbidity and mortality. One of the most serious complications is perforation. Although the incidence of duodenal perforation after ERCP has decreased to < 1.0%, severe cases still require prolonged hospitalization and urgent surgical intervention, potentially leading to permanent disability or mortality. Surgery remains the mainstay treatment for perforations of the luminal organs of the gastrointestinal tract. However, evidence from case reports and case series support a beneficial role of endoscopic clipping in the closure of these defects. Duodenal fistulas are usually a result of sphincterotomies, perforated duodenal ulcers, or gastrectomy. Other causative factors include Crohn’s disease, trauma, pancreatitis, and cancer. The majority of duodenal fistulas heal with nonoperative management. Those that fail to heal are best treated with gastrojejunostomy. Recently proposed endoscopic approaches for managing gastrointestinal leaks caused by fistulas include fibrin glue injection and positioning of endoclips. Our patient developed a secondary persistent duodenal fistula as a result of previous incomplete closure of duodenal perforation with hemoclips and an endoloop. The fistula was successfully repaired by additional clipping and fibrin glue injection.
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23
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Sherman SK, Maxwell JE, Carr JC, Wang D, O'Dorisio MS, O'Dorisio TM, Howe JR. GIPR expression in gastric and duodenal neuroendocrine tumors. J Surg Res 2014; 190:587-93. [PMID: 24565507 DOI: 10.1016/j.jss.2014.01.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/16/2014] [Accepted: 01/24/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Compounds targeting somatostatin-receptor-type-2 (SSTR2) are useful for small bowel neuroendocrine tumor (SBNET) and pancreatic neuroendocrine tumor (PNET) imaging and treatment. We recently characterized expression of 13 cell surface receptor genes in SBNETs and PNETs, identifying three drug targets (GIPR, OXTR, and OPRK1). This study set out to characterize expression of this gene panel in the less common neuroendocrine tumors of the stomach and duodenum (gastric and duodenal neuroendocrine tumors [GDNETs]). METHODS Primary tumors and adjacent normal tissue were collected at surgery, RNA was extracted, and expression of 13 target genes was determined by quantitative polymerase chain reaction. Expression was normalized to GAPDH and POLR2A internal control genes. Expression relative to normal tissue (ddCT) and absolute expression (dCT) were calculated. Wilcoxon tests compared median expression with false discovery rate correction for multiple comparisons. RESULTS Gene expression was similar in two gastric and seven duodenal tumors, and these were analyzed together. Like SBNETs (n = 63) and PNETs (n = 51), GDNETs showed significant overexpression compared with normal tissue of BRS3, GIPR, GRM1, GPR113, OPRK1, and SSTR2 (P < 0.05 for all). Of these, SSTR2 had the highest absolute expression in GDNETs (median dCT 4.0). Absolute expression of BRS3, GRM1, GPR113, and OPRK1 was significantly lower than SSTR2 in GDNETs (P < 0.05 for all), whereas expression of GIPR was similar to SSTR2 (median 4.3, P = 0.4). CONCLUSIONS As in SBNETs and PNETs, GIPR shows absolute expression close to SSTR2 but has greater overexpression relative to normal tissue (21.1 versus 3.5-fold overexpression). We conclude that GIPR could provide an improved signal-to-noise ratio for imaging versus SSTR2 and represents a promising novel therapeutic target in GDNETs.
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Affiliation(s)
- Scott K Sherman
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jessica E Maxwell
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jennifer C Carr
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Donghong Wang
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - M Sue O'Dorisio
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Thomas M O'Dorisio
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - James R Howe
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
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24
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Byrge N, Barton RG, Enniss TM, Nirula R. Laparoscopic versus open repair of perforated gastro duodenal ulcer: a National Surgical Quality Improvement Program analysis. Am J Surg 2013; 206:957-62; discussion 962-3. [PMID: 24112676 DOI: 10.1016/j.amjsurg.2013.08.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/23/2013] [Accepted: 08/21/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical repair of perforated gastroduodenal ulcers remains a common indication for emergent surgery. The aim of this study was to test the hypothesis that the laparoscopic approach (LA) would be associated with reduced length of stay compared to the open approach. METHODS Patients with acute, perforated gastroduodenal ulcer were identified in the National Surgical Quality Improvement Program database, of whom 50 had the LA. One-to-one case/control matching on the basis of age, American Society of Anesthesiologists class, gender, and cardiac disease was evaluated for outcome analysis. RESULTS After matching, the 2 groups had similar characteristics. The rates of wound complications, organ space infections, prolonged ventilation, postoperative sepsis, return to the operating room, and mortality tended to be lower for the LA, although not significantly. Length of hospital stay was, however, significantly shorter for the LA by an average of 5.4 days. CONCLUSIONS The LA appears to be safe in mild to moderately ill patients with perforated peptic ulcer disease and is associated with reduced use of hospital resources.
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Affiliation(s)
- Nickolas Byrge
- Division of General Surgery, Section of Acute Care Surgery, University of Utah, School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, USA.
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25
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Benzekri O, Mouhadi SE, Chourak M, Boussetta S, Absi ME, Echarab M, Elouanani M, Amraoui M, Errougani A, El Alami FH, Chkoff R. Tuberculous duodenal stenosis: report of two cases. Case Rep Gastroenterol 2008; 2:444-50. [PMID: 21897797 PMCID: PMC3166809 DOI: 10.1159/000161566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Duodenal tuberculosis is a rare clinical entity. The authors report and emphasize the lack of special clinical, radiological and endoscopic signs of duodenal tuberculosis. The diagnosis is affirmed, at laparotomy, out of the findings of peritoneal granulations or histology of lymphatic nodes. We report our experience of two cases of duodenal tuberculosis presenting with proximal intestinal obstruction and review the available literature.
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Affiliation(s)
- O Benzekri
- Service des Urgences Chirurgicales Viscérales, CHU Ibn Sina, Rabat, Morocco
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