BACKGROUND Ulcerative colitis(UC)is defined as a chronic inflammatory bowel disease that can occur in any part of the large bowel.In addition,UC affects only the large bowel except for backwash ileitis and pouchitis,w...BACKGROUND Ulcerative colitis(UC)is defined as a chronic inflammatory bowel disease that can occur in any part of the large bowel.In addition,UC affects only the large bowel except for backwash ileitis and pouchitis,whereas Crohn’s disease(CD)affects the entire digestive tract.Inflammatory bowel disease(IBD)patients tend to be diagnosed with CD or indeterminate colitis when combined with gastric lesion.However,in recent years,some UC patients are reported to have various degrees of lesions in gastroduodenum.Here,we report a case of gastroduodenitis associated with UC(GDUC).CASE SUMMARY A 25-year-old man with a history of Klippel-Trenaunay syndrome presented to the hospital with mucopurulent bloody stool and epigastric persistent colic pain for 2 wk.Continuous superficial ulcers and spontaneous bleeding were observed under colonoscopy.Subsequent gastroscopy revealed mucosa with diffuse edema,ulcers,errhysis,and granular and friable changes in the stomach and duodenal bulb,which were similar to the appearance of the rectum.After ruling out other possibilities according to a series of examinations,a diagnosis of GDUC was considered.The patient hesitated about intravenous corticosteroids,so he received a standardized treatment with pentasa of 3.2 g/d.After 0.5 mo of treatment,the patient’s symptoms achieved complete remission.Follow-up endoscopy and imaging findings showed no evidence of recurrence for 26 mo.CONCLUSION The occurrence of gastrointestinal involvement in UC is rare,which may open a new window for studying the etiology and pathogenesis of UC.Physicians should consider broad differential diagnosis by endoscopic biopsy and laboratory examinations.展开更多
Russell bodies are eosinophilic intracytoplasmic globules which are likely the result of disturbed secretion of immunoglobulins that accumulate within the plasma cell. Russell body collections have been identified wit...Russell bodies are eosinophilic intracytoplasmic globules which are likely the result of disturbed secretion of immunoglobulins that accumulate within the plasma cell. Russell body collections have been identified within the stomach, known as Russell body gastritis. Similar lesions within the duodenum are referred to as Russell body duodenitis, which is rare. Several Russell body gastritis case reports are associated with Helicobacter pylori. However, the etiology of Russell body duodenitis remains unclear. Here we report the first case of Russell body duodenitis with immunoglobulin light chain restriction in a background of peptic duodenitis.展开更多
Russell bodies are globular and eosinophilic inclusion bodies in the cytoplasm of mature plasma cells.Plasma cells whose cytoplasm is filled with Russell bodies are designated as Mott cells.Russell body duodenitis(RBD...Russell bodies are globular and eosinophilic inclusion bodies in the cytoplasm of mature plasma cells.Plasma cells whose cytoplasm is filled with Russell bodies are designated as Mott cells.Russell body duodenitis(RBD) is a unique form of chronic duodenitis that is characterized by infiltration of numerous Mott cells.RBD is very rare;only two cases have been reported to date.In this paper,we report a case of RBD in a patient with retroperitoneal metastasis of ureteral cancer.A 77-year-old man was admitted to our hospital complaining of appetite loss,vomiting,and upper abdominal distension.He had undergone left nephroureterectomy for ureteral cancer 4 years earlier.Upper digestive tract endoscopy revealed edema,stenosis,and punctate redness of the mucosa of the duodenum,and a biopsy was performed.Histological analysis showed that numerous Mott cells had infiltrated the lamina propria mucosae,and the condition was diagnosed as RBD.A mass lesion in the retroperitoneum adjacent to the duodenum was detected by abdominal computed tomography,and was diagnosed as metastatic urothelial carcinoma by biopsy.It is possible that chemokines produced by tumor cells caused RBD in this case.展开更多
AIM: To investigate the ultrastructural and morphological changes of non-specific duodenitis (NSD) in an attempt to grade them according to the extent of the lesions. METHODS: Biopsies were taken from the mucosa of du...AIM: To investigate the ultrastructural and morphological changes of non-specific duodenitis (NSD) in an attempt to grade them according to the extent of the lesions. METHODS: Biopsies were taken from the mucosa of duodenal bulb of 44 patients selected from the patients undergoing upper gastrointestinal endoscopy for epigastric discomforts. From each patient, two pinch biopsies on the same area were obtained from duodenal bulb. One was for scanning electron microscopy and the other was stained with hematoxylin-eosin, Warthin-Starry silver and both were then examined under light microscope. A total of 12 specimens (three from each degree of the normal and I-III of NSD diagnosed and graded by histology) selected from the 44 patients were dehydrated, critical point dried, coated with gold palladium and examined under a JEOL JSM-30 scanning electron microscope (SEM) at 20 kV. RESULTS: According to the ultrastructural morphologic changes, non-specific duodenitis was divided into normal (as control group), mild, moderate and severe degrees according to results of SEM. The normal villi of duodenal bulb were less than 0.2 mm. There were inflammation cells, occasionally red blood cells and macrophages on the mucosal epithelial surface. Erosion and desquamation of epithelium could be seen. Three cases (25%, 3/12) had gastric metaplasia and Helicobacter pylori(H pylori) infection could be found in 5 cases (41.67%, 5/12) in duodenal bulb mucosa. The most distinctive feature was the ulcer-like defect on the surface of epithelial cells. CONCLUSION: Non-specific duodenitis is a separate entity disease caused by different factors. SEM is of value as an aid in the diagnosis of mucosal diseases of duodenum.展开更多
Aims: To study the histomorphology of duodenitis associated with systemic autoimmune diseases with clinicopathologic correlation. Patients and Methods: This is a descriptive prospective study. Fifteen patients of auto...Aims: To study the histomorphology of duodenitis associated with systemic autoimmune diseases with clinicopathologic correlation. Patients and Methods: This is a descriptive prospective study. Fifteen patients of autoimmune diseases with duodenitis were included. Informed consent was taken. Histomorphological parameters studied were villous architecture, crypt architecture, intraepithelial lymphocyte (IEL) count per 100 enterocytes, villous tip IEL count per 20 enterocytes were counted, inflammatory cells in lamina propria—lymphocytes, neutrophils, eosinophils, epithelioid cells. Statistical analysis was done using IBM-SPSS software version 21. Results: Fifteen cases of duodenitis associated with autoimmune diseases included 6 patients of systemic lupus erythematosus (SLE), 5 of rheumatoid arthritis, one each of ankylosing spondylitis, systemic sclerosis, dermatomyositis and seronegative reactive arthritis. All these cases were serologically proven. Only 3 (20%) patients had mild villous blunting. Six patients (46.7%) had increased IEL counts. The range of IELs was 8 - 30, mean ± SD was 14 ± 7.6. Range of villous tip IELs was 0 - 8 with mean ± SD of 3.45 ± 2.56. Six patients (46.7%) had increased IEL counts but only 3 patients (20%) had increased villous tip IELs. All patients had moderate increase in lymphoplasmacytic infiltrate in lamina propria. Eosinophils in lamina propria were increased in 46.7% cases.? Conclusion: One of the causes for malabsorptive conditions in adult population in South India is found to be duodenitis associated with autoimmune conditions. We conclude that a combination of clinical, serological, endoscopic and histopathologic features is crucial in arriving at a correct diagnosis.展开更多
A 10-year-old Chinese boy who had a history of congenital thrombocytopathy presented with severe iron deficiency anemia secondary to chronic gastric inflammation and duodenal ulcerations. Subtle oculocutaneous albinis...A 10-year-old Chinese boy who had a history of congenital thrombocytopathy presented with severe iron deficiency anemia secondary to chronic gastric inflammation and duodenal ulcerations. Subtle oculocutaneous albinism led to the finding of diminished dense bodies in the platelets under electron microscopy, hence the diagnosis of Hermansky-Pudlak syndrome (HPS). Biopsies from the stomach and duodenum revealed a lymphocytic infiltration in the submucosa, but H pylori infection was absent. The gastroduodenitis responded to the treatment with omeprazole while iron deficiency anemia was corrected by oral iron therapy. HPS is a rare cause of congenital bleeding disorder with multisystemic manifestations. Upper gastrointestinal involvement is rare and should be distinguished from a mere manifestation of the bleeding diathesis.展开更多
BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver d...BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver disease(NAFLD).However,the specific metabolic contributions of DMA using IRE in NAFLD remain unclear.AIM To assess the feasibility and effectiveness of DMA using IRE in NAFLD rat models.METHODS Seven-week-old male Sprague-Dawley rats underwent DMA using IRE after 8 weeks on a high-fat diet.Two weeks post-treatment,duodenal and liver tissues and blood samples were collected.We evaluated differences in the duodenal wall structure,liver lipid deposition,enteroendocrine,claudin,and zonula ocludens-1 in the duodenal mucosa.RESULTS DMA using IRE could be safely performed in rats with NAFLD without duodenal bleeding,perforation,or stenosis.The duodenum healed well 2 weeks after DMA and was characterized by slimmer villi,narrower and shallower crypts,and thicker myenterons compared with the sham-control setting.Liver lipid deposition was reduced and serum lipid index parameters were considerably improved in the DMA setting.However,these improvements were independent of food intake and weight loss.In addition,enteroendocrine parameters,such as claudin,and zonula ocludens-1 levels in the duodenal mucosa,differed between the different settings in the DMA group.CONCLUSION By altering enteroendocrine and duodenal permeability,simple DMA using IRE ameliorated liver lipid deposition and improved serum lipid parameters in NAFLD rats.展开更多
Helicobacter pylori(H.pylori)infection plays a critical role in gastric diseases,impacting the microbiota structure in gastric and duodenal ulcers.In their study,Jin et al utilized metagenomic sequencing to analyze mu...Helicobacter pylori(H.pylori)infection plays a critical role in gastric diseases,impacting the microbiota structure in gastric and duodenal ulcers.In their study,Jin et al utilized metagenomic sequencing to analyze mucosal samples from patients with ulcers and healthy controls,revealing significant changes in microbial diversity and composition.This article reviews their findings,emphasizing H.pylori’s role in gastric ulcers and the need for further research on its impact on duodenal ulcers.We evaluate the study’s strengths and limitations,suggesting future research directions to enhance our understanding of H.pylori’s contribution to ulcerative diseases.展开更多
Duodenal cancer,a rare gastrointestinal malignancy(30%-45%of small bowel cancers),shows improved outcomes with multidisciplinary advances.Endoscopic resection is preferred for early-stage(Tis/T1)tumors(66%usage),enhan...Duodenal cancer,a rare gastrointestinal malignancy(30%-45%of small bowel cancers),shows improved outcomes with multidisciplinary advances.Endoscopic resection is preferred for early-stage(Tis/T1)tumors(66%usage),enhancing survival(hazard ratio[HR]:0.70)and reducing infection-related mortality vs surgery(P=0.03).Advanced cases rely on surgical resection(segmental/Whipple,46.4%5-year survival)with minimally invasive techniques reducing blood loss.Poor prognosis links to nodal metastasis(HR:2.58)and vascular invasion(HR:2.18).Patients with stage III disease benefit from FOLFOX chemotherapy(HR:0.55),while neoadjuvant chemoradiotherapy improves resectability.Targeted therapies(erb-b2 receptor tyrosine kinase 2/epidermal growth factor receptor/phosphatidylinositol-3-kinase-protein kinase B-mechanistic target of rapamycin kinase)yield complete responses with trastuzumab-chemotherapy combinations.Immunotherapy(pembrolizumab)achieves organ preservation in microsatellite instability-high/mismatch repair-deficient locally advanced tumors.Molecular profiling(caudal type homeobox 2,cell-free DNA,microsatellite instability)guides personalized therapy.Future priorities include global collaborations for precision strategies and novel biomarkers,integrating surgical,targeted,and immunotherapeutic advances to optimize survival and quality of life.展开更多
BACKGROUND Muco-submucosal elongated polyps(MSEPs)are rare benign gastrointestinal lesions,typically reported in the colon and seldom observed in the small intestine.These polyps are generally slow-growing and asympto...BACKGROUND Muco-submucosal elongated polyps(MSEPs)are rare benign gastrointestinal lesions,typically reported in the colon and seldom observed in the small intestine.These polyps are generally slow-growing and asymptomatic,making diagnosis and management challenging.Rapid enlargement of MSEPs in the duodenum is particularly rare and may raise suspicion for neoplastic potential.CASE SUMMARY We report the case of a 64-year-old female who presented with nausea and abdominal pain.Abdominal computed tomography revealed a soft tissue density in the descending duodenum.Upper endoscopy performed 15 months earlier had identified a 1.5-cm mucosal elevation in the second portion of the duodenum.On follow-up endoscopy,the lesion had enlarged significantly into a 10-cm elongated,pedunculated polyp.Endoscopic submucosal dissection was performed for complete en bloc resection.Histopathology confirmed the diagnosis of a MSEP,with no evidence of malignancy.Surveillance endoscopy performed one year after resection showed no recurrence.CONCLUSION Although MSEPs are typically benign,our case demonstrates that rapid growth may occur.This highlights the importance of continued endoscopic surveillance and early intervention,even in asymptomatic patients,to prevent potential complications and ensure timely diagnosis.展开更多
BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct p...BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.展开更多
BACKGROUND Endoscopic ultrasound-guided biliary drainage,including endoscopic ultrasoundguided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy(EUS-HGS),is an efficacious alternative to endosc...BACKGROUND Endoscopic ultrasound-guided biliary drainage,including endoscopic ultrasoundguided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy(EUS-HGS),is an efficacious alternative to endoscopic retrograde cholangiopancreatography and its common complications are bile leak,infection,stent migration and bleeding.Here,we report an atypical case of a patient who developed unexplained dark green urine after receiving EUS-HGS,which we suspected to be caused by an abnormal biliary-vascular fistula.CASE SUMMARY A 76-year-old woman diagnosed with pancreatic adenocarcinoma received EUSHGS for relieving jaundice.The patient reported abdominal pain and chest tightness after the operation,with difficulty in urinating.X-ray suggested rightsided pleural effusion and dark green pleural effusion was drained out.However,the patient also developed dark green urine,which appeared everyday afternoon and disappeared automatically after intravenous treatment.The previous pleural effusion disappeared after one week,but later the patient showed an increase of ascites,and the lesions were compartmentalized and encapsulated internally.CONCLUSION Postoperative surveillance after EUS-HGS must be emphasized to check for in order to prevent severe and hidden complications.展开更多
BACKGROUND Duodenal adenocarcinoma(DA),a rare gastrointestinal malignancy,lacks clear natural history and management strategies.This study aimed to investigate the long-term outcomes of patients with DA,focusing on lo...BACKGROUND Duodenal adenocarcinoma(DA),a rare gastrointestinal malignancy,lacks clear natural history and management strategies.This study aimed to investigate the long-term outcomes of patients with DA,focusing on long-term survival and the impact of tumor characteristics,surgery,and adjuvant therapy.AIM To bridge this knowledge gap,we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA,along with analyzing the impact of the tumor characteristics,operations and adjuvant therapy on survival outcomes.METHODS A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed.This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics,clinical presentation,treatment modalities,and survival outcomes.The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival(OS)and disease-free survival was evaluated using Kaplan-Meier survival curves,the Cox proportional hazards model,and statistical comparisons of survival distributions.RESULTS The median OS time for the cohort was 39 months,with 3-and 5-year OS rates of 51.2%and 43.6%,respectively.Radical resection was performed in 82.6%of cases,and was significantly associated with an improved 5-year OS,with a rate of 57.8%.Adjuvant therapy showed a survival benefit in the specific patient subsets,particularly in tumor stage Ⅱ or Ⅲ tumors,with an improved OS.Adjuvant therapy(hazard ratio=2.71,95%confidence interval:1.30-5.62,P=0.008),pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.CONCLUSION Radical operation for DA is associated with a remarkable improvement in the 5-year OS.Importantly,postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation,especially in patients with stage III.It highlights the necessity for early diagnosis,tailored surgical approaches,and a nuanced understanding of the role of adjuvant therapy.展开更多
BACKGROUND Duodenal stump fistula(DSF)is a rare yet serious complication following gastric cancer surgery.The risk factors associated with DSF,as well as the predictive models,remain insufficiently elucidated.AIM To i...BACKGROUND Duodenal stump fistula(DSF)is a rare yet serious complication following gastric cancer surgery.The risk factors associated with DSF,as well as the predictive models,remain insufficiently elucidated.AIM To identify DSF risk factors following radical gastrectomy with Roux-en-Y anastomosis,develop a predictive model,and evaluate impact on prognosis.METHODS This retrospective cohort study was conducted on patients undergoing radical gastrectomy with Roux-en-Y anastomosis for gastric cancer at Juntendo University from 2015 to 2021(n=325).Univariate and multivariate analyses were performed to identify the risk factors associated with DSF.Based on the independent risk factors,a predictive nomogram was developed and subsequently evaluated using receiver operating characteristic curve analysis.Kaplan-Meier survival curves were utilized to assess the impact of DSF on overall survival(OS),cancerspecific survival(CSS),and disease-free survival(DFS).RESULTS Among the 325 patients analyzed,DSF was observed in 7(2.2%)cases.No DSF was observed in 110 patients where the duodenal stump suturing fixation technique to the jejunal wall was used.Multivariate analysis confirmed that age[odds ratio(OR)=1.17,P=0.015]and obstructive ventilatory failure(OVF)(OR=14.03,P=0.001)were independent risk factors for DSF.The predictive nomogram was constructed based on age and OVF,which exhibited strong performance(area under the curve=0.90,95%confidence interval:0.82-0.99).Kaplan-Meier analysis revealed a statistically significant reduction in CSS for patients with DSF,whereas no significant differences were observed in OS or DFS.CONCLUSION Age and OVF are independent risk factors for DSF,which worsens CSS.A nomogram predicts DSF accurately,and innovative surgical techniques may reduce its occurrence.展开更多
Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,...Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.展开更多
Background:The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications.This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of co...Background:The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications.This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of common bile duct(CBD)stones.Methods:This retrospective study was conducted at Bishan Hospital of Chongqing Medical University between January 2018 and August 2022.Patients with native papillae who underwent endoscopic treatment for CBD stones were recruited and divided into four groups according to Haraldsson's classification of papillae(typesⅠ-Ⅳ).Univariate and multivariate logistic regression analyses were used to identify risk factors for difficult cannulation and post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).Results:A total of 596 patients with CBD stones were enrolled.The proportion of patients with typeⅠpapilla was the highest(n=231,38.8%),followed by typeⅢpapilla(n=175,29.4%),typeⅣpapilla(n=101,16.9%)and typeⅡpapilla(n=89,14.9%).Difficult cannulation occurred in 188 of 596 patients(31.5%),with most cases occurring in those with typeⅢpapilla(71/175,40.6%,P=0.020).Multivariate logistic analysis revealed that age[odds ratio(OR)=1.034,95%confidence interval(CI):1.021–1.047,P<0.001],typeⅢpapilla(OR=2.255,95%CI:1.439–3.535,P<0.001),gallbladder in situ(OR=2.486,95%CI:1.346–4.590,P=0.004),and CBD diameter<10 mm(OR=1.600,95%CI:1.049–2.441,P=0.029)were risk factors for difficult cannulation.The total incidence of PEP was 10.9%.Compared with the other types of papillae,the rate of PEP was the highest in those with typeⅠpapilla(15.2%,P=0.030).Multivariate analysis demonstrated that PEP was associated with difficult cannulation(OR=1.811,95%CI:1.044–3.143,P=0.035)and white blood cells(WBCs)<10×10~9/L(OR=2.199,95%CI:1.051–4.600,P=0.036).Conclusions:The endoscopic appearance of the major papilla is an important factor that influences both biliary cannulation and outcomes.TypeⅢpapilla is more frequently difficult to cannulate in the endoscopic treatment of CBD stones.展开更多
Targeting the gut-liver axis has emerged as a promising strategy in the treatment of metabolic dysfunction-associated steatotic liver disease(MASLD),a condition that currently represents the most common cause of chron...Targeting the gut-liver axis has emerged as a promising strategy in the treatment of metabolic dysfunction-associated steatotic liver disease(MASLD),a condition that currently represents the most common cause of chronic liver disease worldwide.Within this axis,the duodenum serves not only as a site of nutrient absorption but also as a metabolic sensor capable of influencing systemic and hepatic homeostasis.We have read with great interest the recent study by Yu et al,investigating the effects of duodenal mucosal ablation(DMA)by irreversible electroporation in a rat model of MASLD.The authors reported remarkable reductions in hepatic lipid content,improvements in serum lipid profiles,and both structural and functional changes in the intestinal mucosa,including alterations in enteroendocrine signaling.These results corroborate the pivotal role of the gut-liver axis in the pathogenesis of MASLD and highlight the potential of minimally invasive approaches targeting the proximal intestine.In this letter,we discuss the broader implications of these findings,emphasizing the translational relevance of intestinal modulation strategies in the comprehensive treatment of MASLD.展开更多
BACKGROUND The duodenum plays a significant role in metabolic regulation,and thickened mucous membranes are associated with insulin resistance.Duodenal mucosal resurfacing(DMR),a new-style endoscopic procedure using h...BACKGROUND The duodenum plays a significant role in metabolic regulation,and thickened mucous membranes are associated with insulin resistance.Duodenal mucosal resurfacing(DMR),a new-style endoscopic procedure using hydrothermal energy to ablate this thickened layer,shows promise for enhancing glucose and lipid metabolism in type 2 diabetes(T2D)patients.However,the mechanisms driving these improvements remain largely unexplored.AIM To investigate the mechanisms by which DMR improves metabolic disorders using a rat model.METHODS Rats with T2D underwent a revised DMR procedure via a gastric incision using a specialized catheter to abrade the duodenal mucosa.The duodenum was evaluated using histology,immunofluorescence,and western blotting.Serum assays measured glucose,lipid profiles,lipopolysaccharide,and intestinal hormones,while the gut microbiota and metabolomics profiles were analyzed through 16S rRNA gene sequencing and ultra performance liquid chromatography-mass spectrum/mass spectrum,severally.RESULTS DMR significantly improved glucose and lipid metabolic disorders in T2D rats.It increased the serum levels of cholecystokinin,gastric inhibitory peptide,and glucagon-like peptide 1,and reduced the length and depth of duodenal villi and crypts.DMR also enhanced the intestinal barrier integrity and reduced lipopolysaccharide translocation.Additionally,DMR modified the gut microbiome and metabolome,particularly affecting the Blautia genus.Correlation analysis revealed significant links between the gut microbiota,metabolites,and T2D phenotypes.CONCLUSION This study illustrates that DMR addresses metabolic dysfunctions in T2D through multifaceted mechanisms,highlighting the potential role of the Blautia genus on T2D pathogenesis and DMR’s therapeutic impact.展开更多
BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic co...BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic complications and perforations.Satisfactory suturing is crucial for reducing the occurrence of complications.AIM To establish a clinical score model for supporting suture decision-making of duodenal SMTs.METHODS This study included 137 individuals diagnosed with duodenal SMTs who under-went ER.Participants were evenly divided into two groups:A training cohort(TC)comprising 95 cases and an internal validation cohort(VC)with 42 cases.Subsequently,a scoring system was formulated utilizing multivariate logistic regression analysis within the TC,which was then subjected to evaluation in the VC.RESULTS The clinical scoring system incorporated two key factors:Extraluminal growth,which was assigned 2 points,and endoscopic full-thickness resection,which was given 3 points.This model demonstrated strong predictive accuracy,as evidenced by the area under the receiver operating characteristic curve of 0.900(95%confidence interval:0.823-0.976).Additionally,the model’s goodness-of-fit was validated by the Hosmer-Lemeshow test(P=0.404).The probability of purse-string suturing in low(score 0-2)and high(score>3)categories were 3.0%and 64.3%in the TC,and 6.1%and 88.9%in the VC,respectively.CONCLUSION This scoring system may function as a beneficial instrumentality for medical practitioners,facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.展开更多
BACKGROUND T/histiocyte-rich large B-cell lymphoma(T/HRBCL)is a highly aggressive subtype of diffuse large B-cell lymphoma characterized histologically by the presence of a few neoplastic large B cells amidst an abund...BACKGROUND T/histiocyte-rich large B-cell lymphoma(T/HRBCL)is a highly aggressive subtype of diffuse large B-cell lymphoma characterized histologically by the presence of a few neoplastic large B cells amidst an abundant background of reactive T lymphocytes and/or histiocytes.T/HRBCL commonly affects the lymph nodes,followed by extranodal sites,such as the spleen,liver,and bone marrow,with rare occurrences in the gastrointestinal tract.Primary gastrointestinal T/HRBCL lacks specific clinical and endoscopic manifestations,and it is difficult to differentiate from inflammatory diseases,nodular lymphocyte predominant Hodgkin lymphoma,and other diseases on a histological basis,thereby hindering early diagnosis.CASE SUMMARY A 63-year-old man was hospitalized with a one-month history of jaundice and weight loss of approximately 3 kg.Laboratory tests revealed increased hepatic parameters in a cholestatic pattern and elevated carbohydrate antigen 19-9 levels.An abdominal computed tomography scan revealed a low-density mass within the descending duodenum and dilation of the bile and pancreatic ducts.He was clinically diagnosed with a duodenal tumor.During surgery,a 7.0 cm×8.0 cm mass was identified within the descending duodenum,so pancreaticoduodenectomy and cholecystectomy were performed.Following operative biopsy,the tumor was diagnosed as primary duodenal T/HRBCL.The patient refused postoperative chemotherapy and died four months after surgery.CONCLUSION Primary duodenal T/HRBCL is an extremely rare and highly aggressive malignancy.The initial treatment strategies should be based on the original site of the tumor,the disease stage,and the patient's physical condition.Chemotherapy-based comprehensive treatment is still the main treatment method for primary gastrointestinal T/HRBCL.展开更多
文摘BACKGROUND Ulcerative colitis(UC)is defined as a chronic inflammatory bowel disease that can occur in any part of the large bowel.In addition,UC affects only the large bowel except for backwash ileitis and pouchitis,whereas Crohn’s disease(CD)affects the entire digestive tract.Inflammatory bowel disease(IBD)patients tend to be diagnosed with CD or indeterminate colitis when combined with gastric lesion.However,in recent years,some UC patients are reported to have various degrees of lesions in gastroduodenum.Here,we report a case of gastroduodenitis associated with UC(GDUC).CASE SUMMARY A 25-year-old man with a history of Klippel-Trenaunay syndrome presented to the hospital with mucopurulent bloody stool and epigastric persistent colic pain for 2 wk.Continuous superficial ulcers and spontaneous bleeding were observed under colonoscopy.Subsequent gastroscopy revealed mucosa with diffuse edema,ulcers,errhysis,and granular and friable changes in the stomach and duodenal bulb,which were similar to the appearance of the rectum.After ruling out other possibilities according to a series of examinations,a diagnosis of GDUC was considered.The patient hesitated about intravenous corticosteroids,so he received a standardized treatment with pentasa of 3.2 g/d.After 0.5 mo of treatment,the patient’s symptoms achieved complete remission.Follow-up endoscopy and imaging findings showed no evidence of recurrence for 26 mo.CONCLUSION The occurrence of gastrointestinal involvement in UC is rare,which may open a new window for studying the etiology and pathogenesis of UC.Physicians should consider broad differential diagnosis by endoscopic biopsy and laboratory examinations.
文摘Russell bodies are eosinophilic intracytoplasmic globules which are likely the result of disturbed secretion of immunoglobulins that accumulate within the plasma cell. Russell body collections have been identified within the stomach, known as Russell body gastritis. Similar lesions within the duodenum are referred to as Russell body duodenitis, which is rare. Several Russell body gastritis case reports are associated with Helicobacter pylori. However, the etiology of Russell body duodenitis remains unclear. Here we report the first case of Russell body duodenitis with immunoglobulin light chain restriction in a background of peptic duodenitis.
文摘Russell bodies are globular and eosinophilic inclusion bodies in the cytoplasm of mature plasma cells.Plasma cells whose cytoplasm is filled with Russell bodies are designated as Mott cells.Russell body duodenitis(RBD) is a unique form of chronic duodenitis that is characterized by infiltration of numerous Mott cells.RBD is very rare;only two cases have been reported to date.In this paper,we report a case of RBD in a patient with retroperitoneal metastasis of ureteral cancer.A 77-year-old man was admitted to our hospital complaining of appetite loss,vomiting,and upper abdominal distension.He had undergone left nephroureterectomy for ureteral cancer 4 years earlier.Upper digestive tract endoscopy revealed edema,stenosis,and punctate redness of the mucosa of the duodenum,and a biopsy was performed.Histological analysis showed that numerous Mott cells had infiltrated the lamina propria mucosae,and the condition was diagnosed as RBD.A mass lesion in the retroperitoneum adjacent to the duodenum was detected by abdominal computed tomography,and was diagnosed as metastatic urothelial carcinoma by biopsy.It is possible that chemokines produced by tumor cells caused RBD in this case.
文摘AIM: To investigate the ultrastructural and morphological changes of non-specific duodenitis (NSD) in an attempt to grade them according to the extent of the lesions. METHODS: Biopsies were taken from the mucosa of duodenal bulb of 44 patients selected from the patients undergoing upper gastrointestinal endoscopy for epigastric discomforts. From each patient, two pinch biopsies on the same area were obtained from duodenal bulb. One was for scanning electron microscopy and the other was stained with hematoxylin-eosin, Warthin-Starry silver and both were then examined under light microscope. A total of 12 specimens (three from each degree of the normal and I-III of NSD diagnosed and graded by histology) selected from the 44 patients were dehydrated, critical point dried, coated with gold palladium and examined under a JEOL JSM-30 scanning electron microscope (SEM) at 20 kV. RESULTS: According to the ultrastructural morphologic changes, non-specific duodenitis was divided into normal (as control group), mild, moderate and severe degrees according to results of SEM. The normal villi of duodenal bulb were less than 0.2 mm. There were inflammation cells, occasionally red blood cells and macrophages on the mucosal epithelial surface. Erosion and desquamation of epithelium could be seen. Three cases (25%, 3/12) had gastric metaplasia and Helicobacter pylori(H pylori) infection could be found in 5 cases (41.67%, 5/12) in duodenal bulb mucosa. The most distinctive feature was the ulcer-like defect on the surface of epithelial cells. CONCLUSION: Non-specific duodenitis is a separate entity disease caused by different factors. SEM is of value as an aid in the diagnosis of mucosal diseases of duodenum.
文摘Aims: To study the histomorphology of duodenitis associated with systemic autoimmune diseases with clinicopathologic correlation. Patients and Methods: This is a descriptive prospective study. Fifteen patients of autoimmune diseases with duodenitis were included. Informed consent was taken. Histomorphological parameters studied were villous architecture, crypt architecture, intraepithelial lymphocyte (IEL) count per 100 enterocytes, villous tip IEL count per 20 enterocytes were counted, inflammatory cells in lamina propria—lymphocytes, neutrophils, eosinophils, epithelioid cells. Statistical analysis was done using IBM-SPSS software version 21. Results: Fifteen cases of duodenitis associated with autoimmune diseases included 6 patients of systemic lupus erythematosus (SLE), 5 of rheumatoid arthritis, one each of ankylosing spondylitis, systemic sclerosis, dermatomyositis and seronegative reactive arthritis. All these cases were serologically proven. Only 3 (20%) patients had mild villous blunting. Six patients (46.7%) had increased IEL counts. The range of IELs was 8 - 30, mean ± SD was 14 ± 7.6. Range of villous tip IELs was 0 - 8 with mean ± SD of 3.45 ± 2.56. Six patients (46.7%) had increased IEL counts but only 3 patients (20%) had increased villous tip IELs. All patients had moderate increase in lymphoplasmacytic infiltrate in lamina propria. Eosinophils in lamina propria were increased in 46.7% cases.? Conclusion: One of the causes for malabsorptive conditions in adult population in South India is found to be duodenitis associated with autoimmune conditions. We conclude that a combination of clinical, serological, endoscopic and histopathologic features is crucial in arriving at a correct diagnosis.
文摘A 10-year-old Chinese boy who had a history of congenital thrombocytopathy presented with severe iron deficiency anemia secondary to chronic gastric inflammation and duodenal ulcerations. Subtle oculocutaneous albinism led to the finding of diminished dense bodies in the platelets under electron microscopy, hence the diagnosis of Hermansky-Pudlak syndrome (HPS). Biopsies from the stomach and duodenum revealed a lymphocytic infiltration in the submucosa, but H pylori infection was absent. The gastroduodenitis responded to the treatment with omeprazole while iron deficiency anemia was corrected by oral iron therapy. HPS is a rare cause of congenital bleeding disorder with multisystemic manifestations. Upper gastrointestinal involvement is rare and should be distinguished from a mere manifestation of the bleeding diathesis.
基金Supported by the National Key Research and Development Program,No.2023YFF0713700 and No.2023YFF0713705Common Technology R&D Platform of Shaanxi Province,No.2023GXJS-01-1-2the Cyrus Tang Foundation Chung Ying Young Scholars Program.
文摘BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver disease(NAFLD).However,the specific metabolic contributions of DMA using IRE in NAFLD remain unclear.AIM To assess the feasibility and effectiveness of DMA using IRE in NAFLD rat models.METHODS Seven-week-old male Sprague-Dawley rats underwent DMA using IRE after 8 weeks on a high-fat diet.Two weeks post-treatment,duodenal and liver tissues and blood samples were collected.We evaluated differences in the duodenal wall structure,liver lipid deposition,enteroendocrine,claudin,and zonula ocludens-1 in the duodenal mucosa.RESULTS DMA using IRE could be safely performed in rats with NAFLD without duodenal bleeding,perforation,or stenosis.The duodenum healed well 2 weeks after DMA and was characterized by slimmer villi,narrower and shallower crypts,and thicker myenterons compared with the sham-control setting.Liver lipid deposition was reduced and serum lipid index parameters were considerably improved in the DMA setting.However,these improvements were independent of food intake and weight loss.In addition,enteroendocrine parameters,such as claudin,and zonula ocludens-1 levels in the duodenal mucosa,differed between the different settings in the DMA group.CONCLUSION By altering enteroendocrine and duodenal permeability,simple DMA using IRE ameliorated liver lipid deposition and improved serum lipid parameters in NAFLD rats.
文摘Helicobacter pylori(H.pylori)infection plays a critical role in gastric diseases,impacting the microbiota structure in gastric and duodenal ulcers.In their study,Jin et al utilized metagenomic sequencing to analyze mucosal samples from patients with ulcers and healthy controls,revealing significant changes in microbial diversity and composition.This article reviews their findings,emphasizing H.pylori’s role in gastric ulcers and the need for further research on its impact on duodenal ulcers.We evaluate the study’s strengths and limitations,suggesting future research directions to enhance our understanding of H.pylori’s contribution to ulcerative diseases.
基金Supported by Research Projects of Biomedical Center of Hubei Cancer Hospital,No.2022SWZX072023-2024 Annual Scientific Research Project of Traditional Chinese Medicine from Hubei Provincial Administration of Traditional Chinese Medicine,No.ZY2023Z005Health Commission of Hubei Province Scientific Research Project,No.WJ2023Z011.
文摘Duodenal cancer,a rare gastrointestinal malignancy(30%-45%of small bowel cancers),shows improved outcomes with multidisciplinary advances.Endoscopic resection is preferred for early-stage(Tis/T1)tumors(66%usage),enhancing survival(hazard ratio[HR]:0.70)and reducing infection-related mortality vs surgery(P=0.03).Advanced cases rely on surgical resection(segmental/Whipple,46.4%5-year survival)with minimally invasive techniques reducing blood loss.Poor prognosis links to nodal metastasis(HR:2.58)and vascular invasion(HR:2.18).Patients with stage III disease benefit from FOLFOX chemotherapy(HR:0.55),while neoadjuvant chemoradiotherapy improves resectability.Targeted therapies(erb-b2 receptor tyrosine kinase 2/epidermal growth factor receptor/phosphatidylinositol-3-kinase-protein kinase B-mechanistic target of rapamycin kinase)yield complete responses with trastuzumab-chemotherapy combinations.Immunotherapy(pembrolizumab)achieves organ preservation in microsatellite instability-high/mismatch repair-deficient locally advanced tumors.Molecular profiling(caudal type homeobox 2,cell-free DNA,microsatellite instability)guides personalized therapy.Future priorities include global collaborations for precision strategies and novel biomarkers,integrating surgical,targeted,and immunotherapeutic advances to optimize survival and quality of life.
文摘BACKGROUND Muco-submucosal elongated polyps(MSEPs)are rare benign gastrointestinal lesions,typically reported in the colon and seldom observed in the small intestine.These polyps are generally slow-growing and asymptomatic,making diagnosis and management challenging.Rapid enlargement of MSEPs in the duodenum is particularly rare and may raise suspicion for neoplastic potential.CASE SUMMARY We report the case of a 64-year-old female who presented with nausea and abdominal pain.Abdominal computed tomography revealed a soft tissue density in the descending duodenum.Upper endoscopy performed 15 months earlier had identified a 1.5-cm mucosal elevation in the second portion of the duodenum.On follow-up endoscopy,the lesion had enlarged significantly into a 10-cm elongated,pedunculated polyp.Endoscopic submucosal dissection was performed for complete en bloc resection.Histopathology confirmed the diagnosis of a MSEP,with no evidence of malignancy.Surveillance endoscopy performed one year after resection showed no recurrence.CONCLUSION Although MSEPs are typically benign,our case demonstrates that rapid growth may occur.This highlights the importance of continued endoscopic surveillance and early intervention,even in asymptomatic patients,to prevent potential complications and ensure timely diagnosis.
文摘BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.
基金Supported by the National Key Research and Development Program,No.2023YFC2307001the National Natural Science Foundation of China,No.82170570,No.82270698,and No.82470679.
文摘BACKGROUND Endoscopic ultrasound-guided biliary drainage,including endoscopic ultrasoundguided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy(EUS-HGS),is an efficacious alternative to endoscopic retrograde cholangiopancreatography and its common complications are bile leak,infection,stent migration and bleeding.Here,we report an atypical case of a patient who developed unexplained dark green urine after receiving EUS-HGS,which we suspected to be caused by an abnormal biliary-vascular fistula.CASE SUMMARY A 76-year-old woman diagnosed with pancreatic adenocarcinoma received EUSHGS for relieving jaundice.The patient reported abdominal pain and chest tightness after the operation,with difficulty in urinating.X-ray suggested rightsided pleural effusion and dark green pleural effusion was drained out.However,the patient also developed dark green urine,which appeared everyday afternoon and disappeared automatically after intravenous treatment.The previous pleural effusion disappeared after one week,but later the patient showed an increase of ascites,and the lesions were compartmentalized and encapsulated internally.CONCLUSION Postoperative surveillance after EUS-HGS must be emphasized to check for in order to prevent severe and hidden complications.
基金Supported by Natural Science Foundation of Guangdong Province of China,No.2023A1515010785Key Clinical Technique of Guangzhou,No.2023P-ZD01Clinical Research Program of Nanfang Hospital,Southern Medical University,No.2021CR003.
文摘BACKGROUND Duodenal adenocarcinoma(DA),a rare gastrointestinal malignancy,lacks clear natural history and management strategies.This study aimed to investigate the long-term outcomes of patients with DA,focusing on long-term survival and the impact of tumor characteristics,surgery,and adjuvant therapy.AIM To bridge this knowledge gap,we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA,along with analyzing the impact of the tumor characteristics,operations and adjuvant therapy on survival outcomes.METHODS A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed.This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics,clinical presentation,treatment modalities,and survival outcomes.The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival(OS)and disease-free survival was evaluated using Kaplan-Meier survival curves,the Cox proportional hazards model,and statistical comparisons of survival distributions.RESULTS The median OS time for the cohort was 39 months,with 3-and 5-year OS rates of 51.2%and 43.6%,respectively.Radical resection was performed in 82.6%of cases,and was significantly associated with an improved 5-year OS,with a rate of 57.8%.Adjuvant therapy showed a survival benefit in the specific patient subsets,particularly in tumor stage Ⅱ or Ⅲ tumors,with an improved OS.Adjuvant therapy(hazard ratio=2.71,95%confidence interval:1.30-5.62,P=0.008),pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.CONCLUSION Radical operation for DA is associated with a remarkable improvement in the 5-year OS.Importantly,postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation,especially in patients with stage III.It highlights the necessity for early diagnosis,tailored surgical approaches,and a nuanced understanding of the role of adjuvant therapy.
基金Supported by the China Scholarship Council Fund,No.202308050094.
文摘BACKGROUND Duodenal stump fistula(DSF)is a rare yet serious complication following gastric cancer surgery.The risk factors associated with DSF,as well as the predictive models,remain insufficiently elucidated.AIM To identify DSF risk factors following radical gastrectomy with Roux-en-Y anastomosis,develop a predictive model,and evaluate impact on prognosis.METHODS This retrospective cohort study was conducted on patients undergoing radical gastrectomy with Roux-en-Y anastomosis for gastric cancer at Juntendo University from 2015 to 2021(n=325).Univariate and multivariate analyses were performed to identify the risk factors associated with DSF.Based on the independent risk factors,a predictive nomogram was developed and subsequently evaluated using receiver operating characteristic curve analysis.Kaplan-Meier survival curves were utilized to assess the impact of DSF on overall survival(OS),cancerspecific survival(CSS),and disease-free survival(DFS).RESULTS Among the 325 patients analyzed,DSF was observed in 7(2.2%)cases.No DSF was observed in 110 patients where the duodenal stump suturing fixation technique to the jejunal wall was used.Multivariate analysis confirmed that age[odds ratio(OR)=1.17,P=0.015]and obstructive ventilatory failure(OVF)(OR=14.03,P=0.001)were independent risk factors for DSF.The predictive nomogram was constructed based on age and OVF,which exhibited strong performance(area under the curve=0.90,95%confidence interval:0.82-0.99).Kaplan-Meier analysis revealed a statistically significant reduction in CSS for patients with DSF,whereas no significant differences were observed in OS or DFS.CONCLUSION Age and OVF are independent risk factors for DSF,which worsens CSS.A nomogram predicts DSF accurately,and innovative surgical techniques may reduce its occurrence.
文摘Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.
文摘Background:The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications.This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of common bile duct(CBD)stones.Methods:This retrospective study was conducted at Bishan Hospital of Chongqing Medical University between January 2018 and August 2022.Patients with native papillae who underwent endoscopic treatment for CBD stones were recruited and divided into four groups according to Haraldsson's classification of papillae(typesⅠ-Ⅳ).Univariate and multivariate logistic regression analyses were used to identify risk factors for difficult cannulation and post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).Results:A total of 596 patients with CBD stones were enrolled.The proportion of patients with typeⅠpapilla was the highest(n=231,38.8%),followed by typeⅢpapilla(n=175,29.4%),typeⅣpapilla(n=101,16.9%)and typeⅡpapilla(n=89,14.9%).Difficult cannulation occurred in 188 of 596 patients(31.5%),with most cases occurring in those with typeⅢpapilla(71/175,40.6%,P=0.020).Multivariate logistic analysis revealed that age[odds ratio(OR)=1.034,95%confidence interval(CI):1.021–1.047,P<0.001],typeⅢpapilla(OR=2.255,95%CI:1.439–3.535,P<0.001),gallbladder in situ(OR=2.486,95%CI:1.346–4.590,P=0.004),and CBD diameter<10 mm(OR=1.600,95%CI:1.049–2.441,P=0.029)were risk factors for difficult cannulation.The total incidence of PEP was 10.9%.Compared with the other types of papillae,the rate of PEP was the highest in those with typeⅠpapilla(15.2%,P=0.030).Multivariate analysis demonstrated that PEP was associated with difficult cannulation(OR=1.811,95%CI:1.044–3.143,P=0.035)and white blood cells(WBCs)<10×10~9/L(OR=2.199,95%CI:1.051–4.600,P=0.036).Conclusions:The endoscopic appearance of the major papilla is an important factor that influences both biliary cannulation and outcomes.TypeⅢpapilla is more frequently difficult to cannulate in the endoscopic treatment of CBD stones.
文摘Targeting the gut-liver axis has emerged as a promising strategy in the treatment of metabolic dysfunction-associated steatotic liver disease(MASLD),a condition that currently represents the most common cause of chronic liver disease worldwide.Within this axis,the duodenum serves not only as a site of nutrient absorption but also as a metabolic sensor capable of influencing systemic and hepatic homeostasis.We have read with great interest the recent study by Yu et al,investigating the effects of duodenal mucosal ablation(DMA)by irreversible electroporation in a rat model of MASLD.The authors reported remarkable reductions in hepatic lipid content,improvements in serum lipid profiles,and both structural and functional changes in the intestinal mucosa,including alterations in enteroendocrine signaling.These results corroborate the pivotal role of the gut-liver axis in the pathogenesis of MASLD and highlight the potential of minimally invasive approaches targeting the proximal intestine.In this letter,we discuss the broader implications of these findings,emphasizing the translational relevance of intestinal modulation strategies in the comprehensive treatment of MASLD.
基金Supported by the National Natural Science Foundation of China,No.82474318the Jiangsu Administration of Traditional Chinese Medicine,No.zt202105+1 种基金Subject of Jiangsu Province Hospital of Chinese Medicine,No.Y2021rc22a Research Career Scientist。
文摘BACKGROUND The duodenum plays a significant role in metabolic regulation,and thickened mucous membranes are associated with insulin resistance.Duodenal mucosal resurfacing(DMR),a new-style endoscopic procedure using hydrothermal energy to ablate this thickened layer,shows promise for enhancing glucose and lipid metabolism in type 2 diabetes(T2D)patients.However,the mechanisms driving these improvements remain largely unexplored.AIM To investigate the mechanisms by which DMR improves metabolic disorders using a rat model.METHODS Rats with T2D underwent a revised DMR procedure via a gastric incision using a specialized catheter to abrade the duodenal mucosa.The duodenum was evaluated using histology,immunofluorescence,and western blotting.Serum assays measured glucose,lipid profiles,lipopolysaccharide,and intestinal hormones,while the gut microbiota and metabolomics profiles were analyzed through 16S rRNA gene sequencing and ultra performance liquid chromatography-mass spectrum/mass spectrum,severally.RESULTS DMR significantly improved glucose and lipid metabolic disorders in T2D rats.It increased the serum levels of cholecystokinin,gastric inhibitory peptide,and glucagon-like peptide 1,and reduced the length and depth of duodenal villi and crypts.DMR also enhanced the intestinal barrier integrity and reduced lipopolysaccharide translocation.Additionally,DMR modified the gut microbiome and metabolome,particularly affecting the Blautia genus.Correlation analysis revealed significant links between the gut microbiota,metabolites,and T2D phenotypes.CONCLUSION This study illustrates that DMR addresses metabolic dysfunctions in T2D through multifaceted mechanisms,highlighting the potential role of the Blautia genus on T2D pathogenesis and DMR’s therapeutic impact.
基金Supported by National Natural Science Foundation of China,No.82170555Shanghai Academic/Technology Research Leader,No.22XD1422400+2 种基金Shanghai“Rising Stars of Medical Talent”Youth Development Program,No.20224Z0005the 74th General Support of China Postdoctoral Science Foundation,No.2023M740675Outstanding Resident Clinical Postdoctoral Program of Zhongshan Hospital Affiliated to Fudan University.
文摘BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic complications and perforations.Satisfactory suturing is crucial for reducing the occurrence of complications.AIM To establish a clinical score model for supporting suture decision-making of duodenal SMTs.METHODS This study included 137 individuals diagnosed with duodenal SMTs who under-went ER.Participants were evenly divided into two groups:A training cohort(TC)comprising 95 cases and an internal validation cohort(VC)with 42 cases.Subsequently,a scoring system was formulated utilizing multivariate logistic regression analysis within the TC,which was then subjected to evaluation in the VC.RESULTS The clinical scoring system incorporated two key factors:Extraluminal growth,which was assigned 2 points,and endoscopic full-thickness resection,which was given 3 points.This model demonstrated strong predictive accuracy,as evidenced by the area under the receiver operating characteristic curve of 0.900(95%confidence interval:0.823-0.976).Additionally,the model’s goodness-of-fit was validated by the Hosmer-Lemeshow test(P=0.404).The probability of purse-string suturing in low(score 0-2)and high(score>3)categories were 3.0%and 64.3%in the TC,and 6.1%and 88.9%in the VC,respectively.CONCLUSION This scoring system may function as a beneficial instrumentality for medical practitioners,facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.
文摘BACKGROUND T/histiocyte-rich large B-cell lymphoma(T/HRBCL)is a highly aggressive subtype of diffuse large B-cell lymphoma characterized histologically by the presence of a few neoplastic large B cells amidst an abundant background of reactive T lymphocytes and/or histiocytes.T/HRBCL commonly affects the lymph nodes,followed by extranodal sites,such as the spleen,liver,and bone marrow,with rare occurrences in the gastrointestinal tract.Primary gastrointestinal T/HRBCL lacks specific clinical and endoscopic manifestations,and it is difficult to differentiate from inflammatory diseases,nodular lymphocyte predominant Hodgkin lymphoma,and other diseases on a histological basis,thereby hindering early diagnosis.CASE SUMMARY A 63-year-old man was hospitalized with a one-month history of jaundice and weight loss of approximately 3 kg.Laboratory tests revealed increased hepatic parameters in a cholestatic pattern and elevated carbohydrate antigen 19-9 levels.An abdominal computed tomography scan revealed a low-density mass within the descending duodenum and dilation of the bile and pancreatic ducts.He was clinically diagnosed with a duodenal tumor.During surgery,a 7.0 cm×8.0 cm mass was identified within the descending duodenum,so pancreaticoduodenectomy and cholecystectomy were performed.Following operative biopsy,the tumor was diagnosed as primary duodenal T/HRBCL.The patient refused postoperative chemotherapy and died four months after surgery.CONCLUSION Primary duodenal T/HRBCL is an extremely rare and highly aggressive malignancy.The initial treatment strategies should be based on the original site of the tumor,the disease stage,and the patient's physical condition.Chemotherapy-based comprehensive treatment is still the main treatment method for primary gastrointestinal T/HRBCL.
