How I do it: Endoscopic diagnosis for superficial non-ampullary duodenal epithelial tumors

Atsushi Nakayama, Motohiko Kato, Yusaku Takatori, Masayuki Shimoda, Mari Mizutani, Koshiro Tsutsumi, Yoshiyuki Kiguchi, Teppei Akimoto, Motoki Sasaki, Makoto Mutaguchi, Kaoru Takabayashi, Tadateru Maehata, Yasutoshi Ochiai, Takanori Kanai, Naohisa Yahagi

Research output: Contribution to journalArticlepeer-review

28 Citations (Scopus)


There are no reports on detailed endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADET) except for relatively small case series. Herein, we conducted a prospective observational study to investigate the relationship between endoscopic findings and histopathological diagnosis of SNADET. A total of 163 SNADET diagnosed using magnified endoscopic examination with image-enhanced endoscopy (IEE-ME) were prospectively registered in this study. We investigated location, size, macroscopic type, color, and IEE-ME findings including surface structure (closed- or open-loop) and presence of white opaque substance (WOS) in SNADET. We analyzed association between these findings and histopathological diagnosis of SNADET based on the Vienna classification (VCL) using logistic regression analysis. In univariate analysis, lesion size, superficial structure, and WOS deposition showed statistical significance, and the oral side of the lesion location showed statistical tendency for association with VCL C4/5. In multivariate analysis, lesion size (odds ratio [OR], 2.92; 95% CI, 1.94–4.39; P < 0.05) and negative WOS (OR, 5.59; 95% CI, 1.72–18.1; P < 0.05) were significantly associated with VCL C4/5 lesions. Superficial structures with a closed-loop pattern on the surface showed statistical tendency for predicting VCL C4/5 lesions (OR, 2.15; 95% CI, 0.86–5.37; P = 0.10). Based on these findings, we concluded that negative WOS by IEE-ME and lesion size were independent predictors of VCL C4/5 SNADET. These factors may help us to understand of pathophysiology of SNADET and to select appropriate therapeutic strategies.

Original languageEnglish
Pages (from-to)417-424
Number of pages8
JournalDigestive Endoscopy
Issue number3
Publication statusPublished - 2020 Mar 1


  • adenoma
  • carcinoma
  • diagnosis
  • duodenal neoplasm
  • endoscopy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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