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Silmoo Park - One of the best experts on this subject based on the ideXlab platform.
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a tubulovillous adenoma of Duodenal Bulb treated by endoscopic mucosal resection
Clinical Endoscopy, 2004Co-Authors: Seungmun Jung, Jaehyuk Do, Sekyoung Chang, Silmoo ParkAbstract:Solitary tubulovillous adenoma of the Duodenal Bulb is a rare tumor, which has not been reported in the Korean literature. Most of Duodenal adenoma is located in the second portion of the duodenum. We report an unusual case of tubulovillous adenoma of the Duodenal Bulb. The lesion was treated by the endoscopic mucosal resection and was histologically diagnosed as tubulovillous adenoma.
David Sanders - One of the best experts on this subject based on the ideXlab platform.
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pwe 119 Duodenal Bulb biopsies for diagnosing adult coeliac disease is there an optimal biopsy site
Gut, 2012Co-Authors: Matthew Kurien, Simon S. Cross, Andrew D. Hopper, Melissa F Hale, K E Evans, David SandersAbstract:Introduction There has been increasing interest in the role that Duodenal Bulb biopsies may have in helping to establish the diagnosis of coeliac disease. This study aims to determine whether a targeted Duodenal Bulb biopsy in addition to distal Duodenal biopsies is the optimal strategy when trying to identify villous atrophy, comparing histological findings from different quadrants of the Duodenal Bulb. Methods Patients undergoing oesophogastroduodenoscopy (OGD) were prospectively recruited from a single tertiary referral hospital in the UK between July 2010 and October 2011. Indications for biopsy included positive coeliac serology, family history of coeliac disease, chronic diarrhoea, iron deficiency anaemia, abdominal pain and weight loss. All patients recruited to the study had immunoglobulin A (IgA) endomysial antibody (EMA) and tissue transglutaminase (tTG) antibody measurements prior to undergoing their EGD. At endoscopy, eight Duodenal biopsies were taken: four from the second part of the duodenum and four quadrantically from the Bulb (3,6,9 and 12 o9clock). Each biopsy was graded according to the modified Marsh Criteria, with the optimal biopsy site in the Bulb being evaluated by the ability to detect the presence and severity of villous atrophy. Results A total of 77 patients were recruited (27 male (35%), 50 female (65%), median age 45, range 19–79) between July 2010 and November 2011. Of these, 28 (36%) were found to have newly diagnosed coeliac disease and 49 were controls (64%). Bulbar villous atrophy was identified in 96% of the coeliac patients, with five patients having villous atrophy confined to the Bulb alone (Abstract PWE-119 table 1). The most severe degree of villous atrophy was detected when distal Duodenal biopsies were taken in addition to a Duodenal Bulb biopsy from either the 9 or 12 o9clock position (sensitivity 96.4%, 95% CI 79.7% to 100%). The difference between the 12 o9clock biopsy and the 3 o9clock biopsy in detecting the most severe villous atrophy was 92% (24/26) vs 65% (17/26) (p=0.04). Conclusion This study demonstrates the patchy appearance of villous atrophy that occurs within the duodenum. A targeted Duodenal Bulb biopsy from either the 9 or 12 o9clock position in addition to distal Duodenal biopsies, may improve diagnostic yields by detecting the most severe villous atrophy within the duodenum. Competing interests None declared.
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oc 049 Duodenal Bulb biopsies are they a necessity in coeliac disease
Gut, 2012Co-Authors: Matthew Kurien, Kate E Evans, Simon S. Cross, Andrew D. Hopper, Marios Hadjivassiliou, Imran Aziz, David SandersAbstract:Introduction Historically, Brunner9s glands in the Bulb were thought to cause histological interpretation difficulties, however recent studies have demonstrated that this area maybe the only site to demonstrate villous atrophy (VA) and thus detect Coeliac Disease (CD). This study evaluates the diagnostic yield of taking Duodenal Bulb biopsies in coeliac patients compared with controls. Methods Patients undergoing clinically indicated oesophogastrodudoenoscopy (OGD) were prospectively recruited from a single tertiary referral centre between November 2008 and December 2011. Indications for OGD included positive coeliac serology, family history of coeliac disease, diarrhoea, iron deficiency anaemia, abdominal pain and weight loss. All biopsies were graded using the Marsh criteria, with patients being assigned to one of three groups: Group 1 (CD: New Diagnosis), Group 2 (CD: Remission) and Group 3 (Controls). Results 550 patients (360 female) with median age 51 (range 15–89 years) were prospectively recruited. 153 had newly diagnosed celiac disease, 91 established celiac disease, and 306 controls. New diagnosis celiac disease (9%, p Conclusion This is the largest prospective study evaluating the value of a Duodenal Bulb biopsy strategy. VA may only be present in the Duodenal Bulb. In this study 14/153 (9%) of newly diagnosed coeliac disease patients and 13/91 (14%) of CD remission patients demonstrated VA in the Bulb alone. We suggest that endoscopists should consider taking a Duodenal Bulb biopsy in patients suspected of having coeliac disease and in reassessment cases. Competing interests None declared.
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OC-049 Duodenal Bulb biopsies—are they a necessity in coeliac disease?
Gut, 2012Co-Authors: Matthew Kurien, Kate E Evans, Simon S. Cross, Andrew D. Hopper, Marios Hadjivassiliou, Imran Aziz, David SandersAbstract:Introduction Historically, Brunner9s glands in the Bulb were thought to cause histological interpretation difficulties, however recent studies have demonstrated that this area maybe the only site to demonstrate villous atrophy (VA) and thus detect Coeliac Disease (CD). This study evaluates the diagnostic yield of taking Duodenal Bulb biopsies in coeliac patients compared with controls. Methods Patients undergoing clinically indicated oesophogastrodudoenoscopy (OGD) were prospectively recruited from a single tertiary referral centre between November 2008 and December 2011. Indications for OGD included positive coeliac serology, family history of coeliac disease, diarrhoea, iron deficiency anaemia, abdominal pain and weight loss. All biopsies were graded using the Marsh criteria, with patients being assigned to one of three groups: Group 1 (CD: New Diagnosis), Group 2 (CD: Remission) and Group 3 (Controls). Results 550 patients (360 female) with median age 51 (range 15–89 years) were prospectively recruited. 153 had newly diagnosed celiac disease, 91 established celiac disease, and 306 controls. New diagnosis celiac disease (9%, p Conclusion This is the largest prospective study evaluating the value of a Duodenal Bulb biopsy strategy. VA may only be present in the Duodenal Bulb. In this study 14/153 (9%) of newly diagnosed coeliac disease patients and 13/91 (14%) of CD remission patients demonstrated VA in the Bulb alone. We suggest that endoscopists should consider taking a Duodenal Bulb biopsy in patients suspected of having coeliac disease and in reassessment cases. Competing interests None declared.
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Duodenal Bulb biopsies for diagnosing adult celiac disease: is there an optimal biopsy site?
Gastrointestinal Endoscopy, 2012Co-Authors: Matthew Kurien, Kate E Evans, Simon S. Cross, Andrew D. Hopper, Melissa F Hale, David SandersAbstract:Background Recent studies highlight the role of Duodenal Bulb biopsy in the diagnosis of celiac disease. Objective To determine whether a targeted Duodenal Bulb biopsy in addition to distal Duodenal biopsies is the optimal strategy to identify villous atrophy. Design Prospective cohort study. Setting Tertiary-care referral center. Patients Seventy-seven patients undergoing clinically indicated EGD with Duodenal biopsies were recruited. Of these, 28 had newly diagnosed celiac disease and 49 were controls. Interventions At endoscopy, 8 Duodenal biopsy specimens were taken: 4 from the second part of the duodenum and 4 quadrantically from the Bulb (at the 3-, 6-, 9-, and 12-o'clock positions). Main Outcome Measurements Increasing the diagnostic yield and detection of the most severe villous atrophy in celiac disease with the addition of a targeted Duodenal Bulb biopsy. Results The most severe degree of villous atrophy was detected when distal Duodenal biopsy specimens were taken in addition to a Duodenal Bulb biopsy specimen from either the 9- or 12-o'clock position (96.4% sensitivity; 95% CI, 79.7%-100%). The difference between the 12-o'clock position biopsy and the 3-o'clock position biopsy in detecting the most severe villous atrophy was 92% (24/26) versus 65% (17/26) ( P = .02). Limitations Small sample and study performed in a tertiary referral center. Conclusions This study demonstrates the patchy appearance of villous atrophy that occurs within the duodenum. A targeted Duodenal Bulb biopsy from either the 9- or 12-o'clock position in addition to distal Duodenal biopsies may improve diagnostic yields by detecting the most severe villous atrophy within the duodenum.
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Routine Duodenal Bulb biopsy in coeliac disease: time to change clinical practice?
Gut, 2011Co-Authors: Kate E Evans, Simon S. Cross, G R Sahota, Andrew D. Hopper, Marios Hadjivassiliou, David SandersAbstract:Introduction Historically Brunner9s glands were thought to interfere with interpretation of villous atrophy in the Duodenal Bulb. Recent reports suggest that the Duodenal Bulb may be the only site to demonstrate villous atrophy (VA) in coeliac disease (CD). There are few data on the prevalence of lesions in non-coeliac patients. Methods We aimed to compare the histological findings in the Duodenal Bulb and distal duodenum of patients with CD against controls having gastroscopy with Duodenal biopsy. Indications included positive coeliac serology, family history, diarrhoea, and iron deficiency anaemia. A total of 461 patients were prospectively recruited. Biopsies were graded using the Marsh criteria by a single pathologist blinded to the clinical information. Results 461 patients, (300 female, 161 male) median age 50 years (range 16–89) were analysed. 24 patients had VA in the Bulb only, 6 had VA in distal duodenum only (p=0.001) (table 1). 1 control patient with HIV enteropathy had VA at both sites. CD in remission showed greater histological variability than new diagnosis CD (p=0.0018) and controls (p=0.0001) Conclusion Villous atrophy may be present only in the Duodenal Bulb. In this study 11/126 (9%) of new diagnosis CD and 12/85 (14%) of CD in remission demonstrated VA in the Bulb alone. We recommend taking a biopsy from the Bulb as well as the distal duodenum to diagnose suspected coeliac disease and reassess known cases.
Seungmun Jung - One of the best experts on this subject based on the ideXlab platform.
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a tubulovillous adenoma of Duodenal Bulb treated by endoscopic mucosal resection
Clinical Endoscopy, 2004Co-Authors: Seungmun Jung, Jaehyuk Do, Sekyoung Chang, Silmoo ParkAbstract:Solitary tubulovillous adenoma of the Duodenal Bulb is a rare tumor, which has not been reported in the Korean literature. Most of Duodenal adenoma is located in the second portion of the duodenum. We report an unusual case of tubulovillous adenoma of the Duodenal Bulb. The lesion was treated by the endoscopic mucosal resection and was histologically diagnosed as tubulovillous adenoma.
Jaehyuk Do - One of the best experts on this subject based on the ideXlab platform.
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a tubulovillous adenoma of Duodenal Bulb treated by endoscopic mucosal resection
Clinical Endoscopy, 2004Co-Authors: Seungmun Jung, Jaehyuk Do, Sekyoung Chang, Silmoo ParkAbstract:Solitary tubulovillous adenoma of the Duodenal Bulb is a rare tumor, which has not been reported in the Korean literature. Most of Duodenal adenoma is located in the second portion of the duodenum. We report an unusual case of tubulovillous adenoma of the Duodenal Bulb. The lesion was treated by the endoscopic mucosal resection and was histologically diagnosed as tubulovillous adenoma.
Sekyoung Chang - One of the best experts on this subject based on the ideXlab platform.
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a tubulovillous adenoma of Duodenal Bulb treated by endoscopic mucosal resection
Clinical Endoscopy, 2004Co-Authors: Seungmun Jung, Jaehyuk Do, Sekyoung Chang, Silmoo ParkAbstract:Solitary tubulovillous adenoma of the Duodenal Bulb is a rare tumor, which has not been reported in the Korean literature. Most of Duodenal adenoma is located in the second portion of the duodenum. We report an unusual case of tubulovillous adenoma of the Duodenal Bulb. The lesion was treated by the endoscopic mucosal resection and was histologically diagnosed as tubulovillous adenoma.
