Primary Duodenal Malignant Tumors Missed at Initial Upper Endoscopy / 대한소화기내시경학회지

ABSTRACT

BACKGROUND/AIMS: Upper endoscopy is an effective method for diagnosing duodenal cancer, however endoscopy sometimes overlook the lesion. METHODS: We did a retrospective review of sixty-eight patients with non-ampullary primary malignant duodenal tumors treated at Samsung Medical Center between 1994 to 2003. Thirteen of 68 patients (20%), whom were not diagnosed by initial endoscopy were analyzed. RESULTS: Twelve were male and mean age were 52.7+/-11.4 years. Histopathologic analysis revealed adenocarcinoma in 10 patients, stromal tumor 2, and lymphoma 1. Weight loss, abdominal pain, bleeding, and vomiting were the presenting symptoms. Initial endoscopy missed the lesion in 9 patients. In 5 patients, location of the lesions were third and fourth portion of the duodenum, difficult to be locations seen by usual endoscopic examination. Four were in the duodenal second portion, and undiagnosed without specific reason. The lesions were seen at initial endoscopy in 4 patients, however biopsy was done in only one patient because the lesion was considered as benign, initially. The median interval to diagnosis from initial upper endoscopy were 35 days (7~109 days). CONCLUSIONS: Some duodenal lesions were missed at initial endoscopic examination. Our study suggests that it is crucial to examine beyond the duodenal bulb and biopsy should be considered when the lesion is not typically looking as benign.