Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy

Figure 8 Suggested algorithm for the management of superficial non-ampullary duodenal epithelial tumor according to depth of invasion; tumor size; endoscopic findings, including magnifying endoscopy; and biopsy results. Endoscopic features of cancer are a red color in the tumor; a nodular, rough surface on conventional white light imaging; a marginal type of milk-white mucosa; an unclassified vascular pattern; a frequency of ill-defined mucosal pattern; and a population of mixed-type lesions with multiple surface patterns on magnifying endoscopy with narrow-band imaging. Endoscopic features of submucosal carcinoma are ulceration and a 0-I or 0-IIa + IIc macroscopic type with a red color. SNADET: Superficial non-ampullary duodenal epithelial tumor; C-WLI: Conventional white-light imaging; M-NBI: Magnifying endoscopy with narrow-band imaging; LDA: Low-grade adenoma; EUS: Endoscopic ultrasonography; ER: Endoscopic resection.