Etiological Profile of Duodenal Nodules

Aim: To study the Etiological Profile and Classification of Duodenal Nodules.

Methods: Patients having duodenal nodules on upper GI endoscopy are usually subjected to biopsy of those nodules as per standard protocols. Hence, we have conducted a prospective observational study including all patients with duodenal nodules irrespective of the indication of upper GI endoscopy and their biopsies were taken from July 23 to December 23 at Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi. Patients were subjected to investigations like complete blood count, liver and kidney function tests, viral markers, and IgA tissue transglutaminase. We have categorized duodenal nodules into 3 types depending upon their endoscopic appearance. Type 1: multiple and diffuse (>5 nodules on or between 2 consecutive duodenal folds); Type 2: few and scattered (≤5 nodules on or between 2 consecutive folds); and Type 3: isolated (single). Patients not giving consent were excluded.

Results: Out of 70 patients, 65.7% (46) are of Type 1, 27.2% (19) Type 2, and 7.1% (5) Type 3. Most common biopsy finding was nonspecific duodenitis 40% (28), 26% (18) had duodenitis of any etiology, 13% (9) had celiac disease, 7% (5) had giardiasis, 4% (3) had eosinophilic duodenitis, 4% (3) had adenocarcinoma, 3% (2) neuro-endocrine tumor, and 1.5% (1) had duodenal lipoma and Strongyloides stercoralis infection (incidental on the background of chronic duodenitis) as in Table 1. Neuroendocrine tumor came out to be metastatic small cell neuroendocrine carcinoma. One patient with giardiasis was diagnosed to have combined-variable-immunodeficiency disorder.

Conclusion: As per our study, duodenal nodules can be classified into 3 types; Type 1 followed by Type 2 and then Type 3 as per frequency of occurrence. As per etiologic diversification Type 3 is the most significant followed by Type 2 and then Type 1.

Publication History

Article published online:
22 April 2024