Duodenal Bulb Research Articles

Clinicopathological characteristics of 30 cases of pyloric gland adenoma: a single center case series

ObjectiveTo investigate the clinicopathological characteristics of patients with pyloric gland adenoma (PGA), as well as their prognosis.MethodsData of 30 cases from 24 patients, who had been histologically diagnosed as PGA, was retrospectively analyzed. Clinical characteristics, histopathological features, treatment and prognosis were assessed and analyzed.ResultsAmong the 24 patients, there were 15 females and 9 males, with an average age of 59 years old. Ten cases were located in the stomach, 4 in the duodenal bulb and 16 in the gallbladder. The average maximum diameter was 13.5 mm and morphologically the vast majority were type 0-I. The assessment of the background mucosa identified autoimmune gastritis (AIG), Helicobacter Pylori-associated gastritis and familial adenomatous polyposis (FAP) in the stomach, ectopic gastric mucosa in the duodenum and chronic cholecystitis in the gallbladder. Endoscopic resection was performed on the vast majority of gastric and duodenal cases, while all gallbladder PGAs underwent cholecystectomy. Histologically, 33.3% of PGAs showed high-grade dysplasia.ConclusionsDue to malignant potential, it is recommended that PGAs should be completely resected, especially if they are large or show high-grade features. For gastric and duodenal PGAs, endoscopic resection has been proven to be safe and effective. Whether PGAs occurring in the gallbladder and stomach are different tumors still requires more cases for further study.

Gastric outlet and duodenal bulb obstruction: A rare complication due to migrated gastrostomy tube.

Gastric outlet and duodenal bulb obstruction: A rare complication due to migrated gastrostomy tube.

Small duodenal adenocarcinoma with peritoneal dissemination mimicking duodenal Brunner’s gland hyperplasia

Introduction: Gastric-phenotype non-ampullary duodenal carcinomas are rare but potentially aggressive tumors. Case Presentation: A 52-year-old woman was referred for a duodenal polyp. Endoscopy revealed multiple duodenal bulb polyps suggestive of Brunner’s gland hyperplasia. Histopathology confirmed well-differentiated tubular adenocarcinoma with submucosal invasion and a positive margin. The patient underwent pancreaticoduodenectomy, and residual subserosal carcinoma was detected. Despite adjuvant chemotherapy, liver metastases and peritoneal dissemination developed 7 months postoperatively. The patient died 24 months after surgery. Conclusion: This case highlights the aggressive nature of gastric-phenotype duodenal adenocarcinoma and the need for early radical surgical intervention when vertical margins are positive after endoscopic resection.

A giant cerebriform submucosal lipoma extending from the gastric body to the duodenal bulb: a case report.

A giant cerebriform submucosal lipoma extending from the gastric body to the duodenal bulb: a case report.

Perioperative management of Hem-o-lok® clip displacement into the duodenal bulb following laparoscopic cholecystectomy: a case report and literature review

Perioperative management of Hem-o-lok® clip displacement into the duodenal bulb following laparoscopic cholecystectomy: a case report and literature review

Association of mucin phenotypes, macroscopic type, and location with invasion depth in early nonampullary duodenal carcinomas

Objective To investigate retrospectively the clinicopathological features of nonampullary duodenal intramucosal carcinoma (M-Ca) and submucosal carcinoma (SM-Ca). Materials and methods Seventy-three patients (67 with M-Ca and seven with SM-Ca) were included. The assessed clinical variables included patient age, sex, treatment procedure, lesion location, color, and macroscopic type. Pathological outcomes included invasion depth, predominant histological type, lymphovascular invasion, and mucin phenotype. Results SM-Ca lesions were predominantly located in the duodenal bulb (28.6%) or the oral side of the major papilla in the second portion (57.1%), while M-Ca lesions were primarily located in the second portion (97.0%) (p = 0.029). The superficially elevated type was predominant in the M-Ca group (43.3%), while the protruded type was predominant in the SM-Ca group (42.9%) (p = 0.034). A submucosal tumor-like appearance was more prevalent in the SM-Ca group (28.6%) than in the M-Ca group (1.5%) (p = 0.022). Well-differentiated adenocarcinomas were predominant in both groups (M-Ca, 97%; SM-Ca, 71.4%), with moderately differentiated and papillary adenocarcinomas being more prevalent in the SM-Ca group (14.3% each) (p = 0.042). The gastric mucin phenotype was significantly more prevalent in the SM-Ca group (71.4%) than in the M-Ca group (2.6%) (p < 0.0001). The median depth of submucosal invasion was 1,200 µm in the SM-Ca group. No lymph node metastasis or recurrence was observed. Conclusions Nonampullary duodenal submucosal carcinomas are characterized by their location on the oral side of the major papilla, protruded macroscopic type, and gastric mucin phenotype. These findings offer insights into distinguishing M-Ca from SM-Ca.

Endoscopic resection of a giant tumor of the submucosal layer of the stomach causing periodic stenosis of its outlet

Background. Lipomas are rare, slow-growing benign mesenchymal neoplasms composed of mature lipocytes, forming accumulations of fatty tissue in the gastrointestinal tract wall, and can occur in any part of it. Gastric lipomas constitute less than 3% of benign and less than 1% of all gastric neoplasms. Minimally invasive laparoscopic surgery is considered the gold standard for treating large non-epithelial neoplasms of the stomach and duodenum. However, with the active introduction of endoscopic intraluminal operations into everyday practice, new promising solutions to this problem are opening up. Objective. To share our experience of removing a giant gastric and duodenal lipoma using endoscopic submucosal dissection (ESD) based on a clinical case. Clinical case. A 53-year-old patient was admitted to the Department of Diagnostic and Therapeutic Endoscopy for further examination and determination of treatment strategy, presenting with complaints of upper abdominal pain, dyspepsia, and vomiting, predominantly after eating and at night. These symptoms were associated with a giant gastric lipoma causing obstruction of the gastric outlet and the duodenum. After consultation with surgeons, the neoplasm was removed using the ESD method in one block, which allowed avoiding resection of the stomach and duodenal bulb. In this case, the lipoma was located in the submucosal layer of the antral region and partially in the duodenal bulb. No complications from the intervention were noted. Conclusion. The presented clinical observation confirms that ESD can be a safe alternative to traditional surgery for the removal of large symptomatic gastric lipomas.

The Characteristics of Isolated Duodenal Bulb Coeliac Disease in Children: A Multicentre Retrospective Study.

A minority of patients with coeliac disease have mucosal pathology limited to the duodenal bulb. We aimed to describe the baseline characteristics of isolated duodenal bulb coeliac disease in children. In this retrospective multicentre study of paediatric patients diagnosed with coeliac disease, based on biopsies obtained separately from the duodenal bulb and distal duodenum, we evaluated the demographic, anthropometric, clinical, associated diseases and coeliac serology characteristics of the patients. Among the 586 children diagnosed with coeliac disease, 459 (78%) were classified as classic and 127 (22%) as isolated duodenal bulb coeliac disease-376 (64.2%) were female and the median age was 7 years (IQR 5-11). In multivariate logistic regression, scalloping of the duodenum (55.1% vs. 17.3%, p < 0.001, OR 4.7, 95% CI 2.8-8), growth impairment (9.8% vs. 9.4%, p = 0.012, OR 2.7, 95% CI 1.4-5.5) and baseline anti-tissue transglutaminase levels > 10 upper limit of norm (71.5% vs. 29.9%, p < 0.001, OR 4.5, 95% CI 2.8-7.2) were associated with a higher probability of having classic coeliac disease. Lack of growth impairment, anti-tissue transglutaminase levels > 10 upper limit of norm and duodenal scalloping are predictive of isolated duodenal bulb involvement, making duodenal bulb biopsies even more important during esophagogastroduodenoscopy for the diagnosis of coeliac disease.

ASO Author Reflections: For Duodenal Bulb Tumors with Submucosal Invasion, Would Distal Gastrectomy with Duodenal Bulb Resection be the Optimal Surgical Procedure?

ASO Author Reflections: For Duodenal Bulb Tumors with Submucosal Invasion, Would Distal Gastrectomy with Duodenal Bulb Resection be the Optimal Surgical Procedure?

Secondary Gallstone Ileus Due to Bouveret Syndrome: Case Report

Bouveret syndrome is an uncommon variant of gallstone ileus, in which a gallstone migrates through a cholecystoduodenal fistula and lodges in the duodenal bulb or stomach, causing a high gastrointestinal obstruction. It accounts for less than 3% of all gallstone ileus cases and typically occurs in elderly patients with multiple comorbidities, being even rarer in young patients without significant clinical history. Symptoms include persistent nausea, vomiting, abdominal pain, and oral intolerance, which can mimic other acute abdomen presentations and delay diagnosis. We present the case of a 45-year-old female patient who arrived at the emergency department with a six-day clinical picture characterized by abdominal distension, constipation, postprandial gastrobiliary vomiting, severe generalized abdominal pain (VAS 10/10), and oral intolerance. Physical examination revealed signs of peritoneal irritation, and imaging studies showed pneumobilia, air-fluid levels, and a stone in the distal ileum. Abdominal computed tomography confirmed the presence of gallstones, pneumobilia, a cholecystoduodenal fistula, and an obstructive stone. An urgent exploratory laparotomy was performed with extraction of the stone via enterolithotomy, primary closure of the enterotomy, fistula repair with a Graham patch, and open cholecystectomy of the remaining gallbladder portion. Postoperative evolution was satisfactory. This case highlights an atypical presentation of Bouveret syndrome in a young patient, as well as the importance of timely diagnosis and comprehensive surgical intervention in managing this rare condition.

Retrospective case study of risk factors, clinical features and laboratory parameters of peptic ulcer disease in pediatric patients

Background: Peptic ulcer disease (PUD) is uncommon in children, yet recognizing risk factors like age, gender and acute illness is crucial. While often in the duodenum, ulcers can also occur in the stomach. Helicobacter pylori is a primary cause of childhood PUD. Complications include bleeding, perforation and penetration. Chronic disease can alter laboratory parameters. Treatment involves H. pylori eradication and sometimes surgery. Methods: This observational retrospective study analyzed electronic medical data from 74 pediatric patients with gastric and/or duodenal ulcers at Health Care Institution-Grodno Regional Children's Clinical Hospital, Belarus (2019-2025). We examined occurrence features, clinical presentation, etiology, complications, laboratory changes and treatment. Results: Common PUD risk factors were identified. Duodenal ulcers predominated (77%). Anatomic localization was compared. Etiologies included H. pylori, stress from chronic disease, diet, long-term hormonal therapy or were unknown. Complications included bleeding and perforation and treatment modalities were determined. Conclusions: In conclusion, it can be noted that peptic ulcers in the group of patients occurred mainly in boys over 10 years old living in the city. According to localization, in most cases, there was an acute ulcer of the duodenal bulb. The leading role in the etiology of ulcers is played by the bacterium Helicobacter pylori, dietary habits and stress. The most common complication was bleeding which needed prompt management. Several laboratory indicators were altered in these patients.

Endoscopic diagnosis and treatment of duodenal neuroendocrine tumours: the experience of the P.A. Hertsen Moscow Oncology Research Institute

The aim of the study was to analyze the results of endoscopic diagnosis and treatment of patients with duodenal neuroendocrine tumors. Material and Methods. From 2012 to 2024, 20 patients diagnosed with duodenal neuroendocrine tumors were examined, and some of them were treated at the Endoscopy Department of P.A. Herzen Moscow Oncology Research Institute. The median age of the patients was 61 years. Tumors were assessed by the following parameters: location, size, pit and vascular pattern, presence of subepithelial vessels, endosonographic structure, depth of invasion, tumor grade, and the type of treatment. Results. The mean tumor size was 8 ± 5.6 mm [95 % CI: 5.4–10.6]. The duodenal bulb was the most common tumor location (87 %) [95 % CI: 69–100 %]. Only in 13 % of cases, tumor was located in the ascending part of the duodenum [95 % CI: 0–30 %]. In the duodenal bulb, tumors were located on its anterior wall in 70 % of cases [95 % CI: 49–90 %], on the medial wall in 18 % of cases [95 % CI: 2–37 %], and on the posterior wall in 12 % of cases [95 % CI: 0–23 %]. Narrow-band imaging endoscopy revealed that 45 % of tumors had an irregular pit pattern and vascular pattern [95 % CI: 23–66 %], and 30 % of tumors consisted of dilated tortuous subepithelial vessels [95 % CI: 9–50 %]. Endoscopic ultrasonography was used to determine the depth of tumor invasion. In most cases, tumors were localized within the second layer corresponding to the muscular plate of the mucosa. Some patients underwent radical endoscopic treatment (EMR and ESD). Conclusion. In our retrospective analysis of clinical cases, we have identified some trends that are consistent with results of other large studies. Endocopic resection is safe and effective treatment option for duodenal neuroendocrine tumors with no evidence of muscle layer invasion and regional and distant metastases.

Evaluation of outcomes of duodenal ulcer perforation closure using single-port laparoscopic surgery

Objective: To investigate the clinical and paraclinical characteristics of patients with perforated duodenal ulcers and to evaluate the outcomes of single-port laparoscopic closure of the perforation. Subject and method: A cross-sectional descriptive study combined with a prospective interventional longitudinal follow-up was conducted on 87 patients with perforated duodenal ulcers who underwent single-port laparoscopic closure from January 2021 to January 2024. Result: Among the 87 patients, the mean age was 52.3 ± 10.7 years, with males accounting for 60.9%, primarily in the 41-60 age group (51.7%). A history of peptic ulcer disease was the most common comorbidity (36.8%). In 79.3% of cases, symptoms began abruptly within 12 hours, with abdominal pain (97.7%) and peritoneal signs (92.0%) as the predominant features. Most patients were classified as Boey score 0 (80.5%). The perforation was located on the anterior duodenal bulb in 63.2% of cases, with a size of 5-10 mm in 66.7%. Diagnosis was mainly based on upright abdominal X-rays (74.7%) and CT scans (67.8%). Closure was performed using an X-stitch in 63.2% of patients, with drain placement in 97.7%. The mean operative time was 74.5 minutes. The complication rate was low (4.5%), and no mortality was reported. Conclusion: Duodenal ulcer perforation predominantly affects middle-aged men and typically presents with classic clinical symptoms and a short onset time. Simple suture closure combined with drainage via single-port laparoscopy yields favorable surgical outcomes.

A Rare Case of Refractory Duodenal Ulcer With Progressive Aggravation Despite Conventional Treatment.

In this case, the patient had an ulcer in the duodenal bulb; however, despite the intensification of acid-suppressive therapy, the ulcer instead progressively worsened. After systematically ruling out potential etiologies, the evidence ultimately pointed to a cholecystectomy performed 11 years prior. Subsequent imaging studies and surgical interventions further corroborated this finding.

Distribution of Lymph Node Metastasis and Prognosis in Duodenal Bulb Tumors: A Multicenter Retrospective Study.

The optimal surgical procedure for primary duodenal cancer has not been established because of its low incidence. The purpose of this study was to examine the distribution of lymph node (LN) metastasis in duodenal bulb tumors. Specifically, in tumors with submucosal invasion, we aimed to evaluate the feasibility of distal gastrectomy with duodenal bulb resection combined with lymphadenectomy of regional gastric LNs. Data from patients who underwent surgery for either adenocarcinoma or neuroendocrine tumors located in the duodenal bulb between 2000 and 2020 were retrospectively analyzed from five high-volume centers in Japan. Patient background, clinicopathological factors, type of surgery, distribution of LN metastasis, and long-term outcomes were evaluated. The frequency of LN metastasis in tumors with submucosal invasion was 18%. Metastatic LNs were identified in T1b adenocarcinomas for #6, #8a, #8p, with similar results for neuroendocrine tumors. The 3-year overall survival rate for adenocarcinoma in stages T1a, T1b, and T2-4 was 100%, 81%, and 56%, respectively. Neuroendocrine tumors were 100% at all depths of invasion. Regarding LN tumors with submucosal invasion, while three patients had a recurrence, two cases were observed in distant organs without regional LNs, and one patient who underwent pancreaticoduodenectomy had metastasis in the gastric regional LNs. For duodenal bulb tumors, based on the distribution of LN metastasis with tumors with submucosal invasion, distal gastrectomy with duodenal bulb resection and regional LN dissection is considered a curative treatment. Conversely, pancreaticoduodenectomy is recommended for tumors invading the muscularis propria and beyond.

A case of duodenal pyloric gland adenoma with high-grade dysplasia arising from ectopic gastric mucosa.

Superficial non-ampullary duodenal epithelial tumor is a rare disease, but its frequency has reportedly been increasing in recent years. We report a case of duodenal pyloric gland adenoma with high-grade dysplasia arising from ectopic gastric mucosa. Esophagogastroduodenoscopy detected a 5-mm raised lesion on the anterior surface of the duodenal bulb. The lesion was diagnosed as gastric foveolar metaplasia with biopsy. A second esophagogastroduodenoscopy was performed 13 years later. The nodule showed a two-stage elevation and a biopsy revealed EGM. The lesion was followed up with EGD almost every year, with enlargement observed each time. Endoscopic submucosal dissection was performed. Histopathological examination revealed pyloric gland adenomawith high-grade dysplasia. Ectopic gastric mucosawas observed in the tumor pathologically and transformation of the EGM into a tumor was followed endoscopically over time.

Olmesartan-associated gastroduodenitis that was detected on endoscopic follow-up

Abstract We present a rare case of olmesartan-associated gastroduodenitis in a 65-year-old female with predominant upper gastrointestinal symptoms and significant changes in endoscopic findings over a short period. The patient presented with epigastralgia and nausea but no diarrhea. Esophagogastroduodenoscopy (EGD) performed 26 months earlier showed a duodenal ulcer and partial mucosal atrophy in the lower gastric body. EGD conducted at our hospital revealed diffuse atrophic mucosa throughout the stomach and fragile mucosa from the middle gastric body to the antrum, with white purulent adhesions. Diffuse inflammatory changes were also observed in the duodenal bulb and descending part. Mucosal biopsy showed atrophic changes, inflammatory cell infiltrations, and epithelial detachments in both the stomach and duodenum. Colonoscopy findings were normal. After discontinuing olmesartan, the patient’s symptoms improved immediately. A follow-up EGD conducted 4 months after discontinuation revealed marked improvement in the stomach and duodenum. At 16 months post-discontinuation, the patient remained asymptomatic, with minimal inflammation and residual gastric atrophy observed on EGD. This case underscores the importance of considering olmesartan as a potential cause of gastroduodenitis, particularly when symptoms and endoscopic findings improve after discontinuation of the medication.

Insufflation of the gastric remnant from a transduodenal approach facilitates percutaneous gastrostomy tube placement in a post Roux-en-Y patient

Percutaneous gastrostomy tube insertion in post Roux-en-Y patients can be challenging due to decompression of the excluded stomach and its discontinuity with the proximal enteric tract. Presented here is a 65-year-old woman status post Roux-en-Y gastric bypass who required gastrostomy tube placement for enteral feeding. The remnant stomach collapsed, and direct percutaneous gastric access was not possible for insufflation. To facilitate insufflation, computed tomography (CT) was used to access the duodenal bulb. This duodenal access was used to insufflate the stomach in a retrograde fashion which created a safe percutaneous window for gastrostomy tube placement into the remnant stomach. The technique described in this study can be a useful tool in patients with difficult to access remnant stomachs. Utilizing either direct or transhepatic access to the duodenum with ultrasound or CT guidance for remnant stomach insufflation can facilitate gastrostomy tube placement in challenging cases.

Management of Refractory Bleeding at the Duodenal Bulb Post-Trauma Using OTSC Combined With Interventional Embolization: A Case Report.

Multiple traumas can lead to acute gastrointestinal mucosal erosion or ulcers, typically presenting as upper gastrointestinal bleeding, while perforation occurs rarely. Rebleeding poses a serious threat to life. Standard treatments include endoscopic electrocoagulation, tissue adhesives, and titanium clips. We report a case of a 39-year-old woman with post-traumatic stress ulcer bleeding successfully managed using a combination of over-the-scope clip (OTSC) placement and interventional embolization. This case demonstrates the effectiveness of OTSC combined with embolization in controlling post-traumatic ulcer bleeding and preventing recurrence.

The Evolution of Double Pylorus Associated With NSAIDs-Induced Gastric Ulcer

Double pylorus is an uncommon condition where two communicating channels between the gastric antrum and duodenal bulb exist and found incidentally by esophagogastroduodenoscopy. This case report presented a 77-year old Timorese man with long-term frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) who came to hospital because of hematemesis and melena. The initial endoscopy showed gastric ulcer and the double pylorus. Nine months later, the double pylorus structure fused into one large opening. This elderly patient with a history of NSAIDs abuse was diagnosed with acquired double pylorus due to a gastric ulcer complication. The fusion of the two channels occurred as a result of septum destruction, likely caused by fistulous tract ulceration or mechanical damage from food bolus. This structure predisposes the patient to bile regurgitation and ulcer recurrence, emphasizing the need for continued monitoring and avoidance of ulcerogenic factors. Keywords : double pylorus, gastroduodenal fistula, NSAIDs, gastric ulcer, follow-up