The mucin phenotype does not affect the endoscopic resection outcome of non-ampullary duodenal epithelial tumors

An 82-year-old man, who underwent pancreatoduodenectomy 14 years earlier for bile duct cancer, was referred for overnight fever. He had been suffering from recurrent fever of unknown origin (FUO) and bacteremia that occurred once every one or two months for the last 3 years. Laboratory tests showed leukocytosis and elevation of Creactive protein (CRP), but his serum pancreatic amylase and lipase levels were in normal range. Computed tomography showed stones in the pancreatic duct without signs of acute pancreatitis (Fig. 1). Singleballoon enteroscopy showed a pancreaticojejunal anastomotic stricture (Fig. 2a), and, after a balloon dilatation, purulent discharge was observed from the anastomosis (Fig. 2b). Finally, two 7-Fr stents were placed across the pancreaticojejunostomy to treat the acute obstructive suppurative pancreatic ductitis (AOSPD) (Fig. 2c). Enterobacter cloacae was identified from blood cultures and pancreatic juice. His fever, leukocytosis, and elevated CRP subsided after 7 days of intravenous ceftriaxone. AOSPD did not recur thereafter, and no further intervention was required until he died of heart failure 16 months later.Acute obstructive suppurative pancreatic ductitis is defined as acute suppuration of the pancreatic duct without concurrent pancreatic abscess or infected pseudocyst. 1,2 Most of the AOSPD patients present with high fever and elevated CRP levels. 3,4 Unlike pancreatitis, pancreatic enzymes are often normal or only slightly elevated in patients with pancreatic ductitis. 3 The diagnosis of AOSPD is confirmed by the finding of pancreatic duct obstruction with evidence of infection, such as positive pancreatic juice culture or purulent pancreatic juice. 4 Although there is no standard treatment, prompt administration of antibiotics and pancreatic duct drainage is the mainstay of the treatment. 3,5 In this case, the patient suffered from recurrent FUO for 3 years. As this case indicates, AOSPD should be considered in the differential diagnosis of FUO, particularly in patients with previous history of pancreatic intervention.

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Initial Tumor Size and Narrow-Band Image Findings Estimate Growth Speed in Duodenal Tumors

Hirose,

Kakushima,

Minami

et al. 2024

Dig Dis

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Introduction: Recently, detection of superficial non-ampullary duodenal epithelial tumors (SNADETs) including adenomas and superficial duodenal carcinomas has increased. Various endoscopic treatment methods have also been reported for SNADETs, but there are few reports on the natural history. The aim of this study was to analyze factors related to tumor growth and determine the characteristics of SNADETs which need early therapeutic intervention. Methods: A single-center, retrospective study was performed on medical records of 309 patients with SNADETs who underwent endoscopic or surgical resection between January 2010 and May 2021. Of these, 41 patients who were followed up for more than one year by endoscopy were analyzed. The primary outcome was analysis of the tumor growth speed. Secondary outcomes were the relationship between the tumor growth speed and mucin phenotype, tumor size and findings of magnifying endoscopy with narrow-band imaging (M-NBI). Results: The observation period was 24 months (13-182). Tumor growth speed was 1.1 mm/year (0-21.6). Tumor diameter >10 mm at first detection (P=0.004; Odds ratio 19.5(2.03-186.96)) and mixed-type by M-NBI (p=0.036; Odds ratio 9.69(1.05-89.88)) were identified as risk factors of tumors growing at a rate of >3 mm/year. There was no statistically significant difference in the speed of tumor growth between the different mucin immunohistochemical phenotype. Conclusion: Initial tumor size and findings of M-NBI are useful to predict tumor growth and consider early intervention.

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The mucin phenotype does not affect the endoscopic resection outcome of non-ampullary duodenal epithelial tumors

Cited by 3 publications

References 29 publications

Treatment of non-ampullary duodenal epithelial tumors: Does phenotype matter?

Treatment of non-ampullary duodenal epithelial tumors: Does phenotype matter?

Revised diagnostic algorithm of magnifying endoscopy with crystal violet staining for non‐ampullary duodenal epithelial tumors

Initial Tumor Size and Narrow-Band Image Findings Estimate Growth Speed in Duodenal Tumors

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