Subepithelial tumors (SETs) in the upper digestive tract are rare and only 10% of are located in the duodenum. Assessment of lesions protruding from the duodenal wall is difficult. Upper gastrointestinal (GI) endoscopy and computed tomography (CT) are not able to completely distinguish between different tumors and guide their subsequent management. Endoscopic ultrasonography (EUS) has a significant diagnostic yield in this context. EUS is able to accurately diagnose duodenal lesions, perform a biopsy if considered useful, guide the approach for resection and provide appropriate follow-up. SETs reported during upper GI endoscopy are more commonly cysts, polyps, lipomas, Brunner’s gland adenoma, ectopic pancreas, gastrointestinal stromal tumors (GISTs) or neuroendocrine tumors (NETs). In addition, although more rarely, adenocarcinomas and lymphomas can be identified. EUS should be performed for any duodenal lesion larger than 1 cm that lacks the endoscopic characteristics of a cyst or a lipoma.
Part of the book: Endoscopy in Small Bowel Diseases
Vonoprazan is a novel potassium-competitive acid blocker that has been introduced as an effective treatment option in peptic ulcer and gastroesophageal reflux diseases. Its adverse events panel is encouraging compared to standard proton pump inhibitors, although higher hypergastrinemia and foveolar-type gastric adenocarcinoma occurrence have been described. The efficiency is proved in gastric and duodenal ulcer, gastroesophageal reflux and gastric post- endoscopic submucosal dissection ulcers, with higher ulcer shrinkage rate and no incremental risk for bleeding. The new therapies containing Vonoprazan instead of convention proton pump inhibitors against Helicobacter pylori are safe and well-tolerated, being associated with a better eradication rate. However, the therapy should be adjusted to the body size.
Part of the book: Peptic Ulcer Disease