Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2023; 11(4): 962-971
Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.962
Three cases of jejunal tumors detected by standard upper gastrointestinal endoscopy: A case series
Jaesun Lee, Sunmoon Kim, Daesung Kim, Sangeok Lee, Kihyun Ryu
Jaesun Lee, Sunmoon Kim, Daesung Kim, Kihyun Ryu, Department of Gastroenterology, Konyang University Myunggok Medical Research Institute, Daejeon 35365, South Korea
Sangeok Lee, Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon 35365, South Korea
Author contributions: Ryu K contributed conceptualization and supervision; Kim S and Ryu K collected and organized the data; Lee J and Ryu K wrote the original draft; Kim S, Kim D and Lee S reviewed and edited the manuscript; all authors have read and agreed to the published version of the manuscript.
Informed consent statement: Written informed consent was not received from the patients, but the reason for the exemption was recognized by the Institutional Review Board of Konyang University Hospital.
Conflict-of-interest statement: All authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kihyun Ryu, MD, PhD, Associate Professor, Department of Gastroenterology, Konyang University Myunggok Medical Research Institute, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, South Korea. medidrug@kyuh.ac.kr
Received: November 22, 2022
Peer-review started: November 22, 2022
First decision: December 19, 2022
Revised: December 27, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: February 6, 2023
Abstract
BACKGROUND

In patients with obscure gastrointestinal bleeding, re-examination with standard upper endoscopes by experienced physicians will identify culprit lesions in a substantial proportion of patients. A common practice is to insert an adult-sized forward-viewing endoscope into the second part of the duodenum. When the endoscope tip enters after the papilla, which is a marker for the descending part of the duodenum, it is difficult to endoscopically judge how far the duodenum has been traversed beyond the second part.

CASE SUMMARY

We experienced three cases of proximal jejunal masses that were diagnosed by standard upper gastrointestinal endoscopy and confirmed with surgery. The patients visited the hospital with a history of melena; during the initial upper gastrointestinal endoscopy and colonoscopy, the bleeding site was not confirmed. Upper gastrointestinal bleeding was suspected; thus, according to guidelines, upper endoscopy was performed again. A hemorrhagic mass was discovered in the small intestine. The lesion of the first patient was thought to be located in the duodenum when considering the general insertion depth of a typical upper gastrointestinal endoscope; however, during surgery, it was confirmed that it was in the jejunum. After the first case, lesions in the second and third patients were detected at the jejunum by inserting the standard upper endoscope as deep as possible.

CONCLUSION

The deep insertion of standard endoscopes is useful for the diagnosis of obscure gastrointestinal bleeding.

Keywords: Esophagogastroduodenoscopy, Obscure gastrointestinal bleeding, Jejunal neoplasm, Case report

Core Tip: In obscure gastrointestinal bleeding, guidelines recommend a second-look endoscopy. If there are negative results, enteroscopy is necessary. However, enteroscope is less commonly used than other endoscopes, and diagnosis may be delayed. We report cases of gastrointestinal stromal tumors in the jejunum diagnosed with standard upper endoscopy and confirmed by surgery. In many cases, we do not know how deep the endoscope was inserted; however, we found the tip of the upper endoscope reached the jejunum and confirmed it through surgery. We recommend inserting an upper gastrointestinal endoscope deeply when performing second-look endoscopy for obscure upper gastrointestinal bleeding.