Response:

Abstract

I appreciate Matsushita et al1Matsushita M. Nishio A. Okazaki K. Effective endoscopic treatment for intraluminal duodenal diverticulum.Gastrointest Endosc. 2018; 87: 1593Abstract Full Text Full Text PDF Scopus (2) Google Scholar for their interest in my article “A rare cause of recurrent acute pancreatitis: duodenal intussusception by a fenestrated duodenum web.”2Koike Y. A rare cause of recurrent acute pancreatitis: duodenum intussusception by a fenestrated duodenal web.Gastrointest Endosc. 2017; 86: 567-568Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar I agree with their assertion that endoscopically treating a fenestrated duodenum web, intraluminal duodenal diverticulum, would be less invasive and effective. Although we also considered endoscopic treatment for intraluminal duodenal diverticulum in this case, we could not determine the major duodenal papilla while performing EGD before surgery, thereby posing a high risk for endoscopic treatment.3Kapuria D. Jonnalagadda S. The “windsock sign”: intraluminal duodenal diverticulum.Clin Gastroenterol Hepatol. 2016; 14: e93-e94Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Furthermore, we prioritized adequate surgical resection of the intraluminal duodenal diverticulum for the developing child in need of total acceptance of oral feeding. Despite the scarcity of reports on the long-term outcome of endoscopic treatment for intraluminal duodenal diverticulum at present,4Anand V. Provost J. Bakr M. et al.Two cases of intraluminal “windsock” diverticula resulting in partial duodenal obstruction.ACG Case Rep J. 2016; 3: e135PubMed Google Scholar endoscopic treatment is anticipated to be a general treatment in the future, as correctly highlighted by Dr Matsushita. Effective endoscopic treatment for intraluminal duodenal diverticulumGastrointestinal EndoscopyVol. 87Issue 6PreviewWe read with interest the article by Koike1 on a patient with recurrent acute pancreatitis caused by a fenestrated duodenal web: intraluminal duodenal diverticulum. On the basis of a duodenum-within-duodenum configuration on CT, a large fenestrated duodenal web on EGD, and a windsock appearance on upper GI series, duodenal intussusception caused by a fenestrated duodenal web was diagnosed. Although the duodenal web was surgically resected with a favorable outcome, we suspect that endoscopic treatment would be a safe and effective alternative. Full-Text PDF