Ischemic treatment of the duodenal windsock web using the ultra-thin endoscope, with modified detachable snares
Notice bibliographique
Résumé
A duodenal web, one of the causes of congenital duodenal obstruction, is a rare congenital anomaly [ 1 ]. Patients with a complete-type duodenal web exhibit duodenal obstruction early in infancy, whereas those with a fenestrated type may be diagnosed with obstruction in adulthood [ 2 ]. In addition, peristalsis and gravity of food can cause the web to balloon distally, taking on the form of a windsock [ 3 ]. This forms a duodenal intraluminal diverticulum. Endoscopic treatment of the duodenal web has become feasible in recent years; however, recurrence and adverse events, including bleeding, are concerning [ 1 ] [ 3 ] [ 4 ]. A 27-year-old woman had experienced occasional vomiting attacks after eating since childhood. She was suspected to have an intraluminal duodenal diverticulum on computed tomography ([ Fig. 1 ]) and was diagnosed with a duodenal windsock web on esophagogastroduodenoscopy ([ Fig. 2 ] a,b ). Fig. 1 Computed tomography revealed a diverticulum in the second portion of the duodenum. Fig. 2 Endoscopic findings. a EGD from the oral side reveals a duodenal diverticulum and orifice similar to a pinhole. The orifice is located at the entrance of the true lumen. b EGD from the anal side reveals a web structuring the diverticulum. The papilla of Vater is found near the web. Abbreviation: EGD, esophagogastroduodenoscopy. An ultra-thin endoscope (EG-530NW, Fujifilm) was passed through the narrow entrance of the true lumen ([ Video 1 ]). After confirming the location of the duodenal papilla in the reflex position, we tightened the neck of the web from the anal side using a detachable snare (HX-400U-30, Olympus) with the sheath removed to induce the web ischemia [ 5 ]. Two days later, the residual mucosa of the web near the necrotic area was tightened using a detachable snare. The following day, the web became entirely necrotic. We cut and removed the snares, made a new entrance to the lumen by penetrating the necrotic mucosa using forceps and scope, and then detained the clips at the side of the entrance. The patient’s abdominal bloating improved postoperatively. The new entrance was kept open, and the contrast medium was passed through the lumen without delay. The patient had no adverse events or recurrences. In conclusion, ischemic treatment in the reflex position is safe for duodenal webs. Endoscopy_UCTN_Code_TTT_1AO_2AG_3AB Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Quality: mobile 360 480 720 Download Case presentation of ischemic treatment for the duodenal windsock web.Video 1 Publication History Article published online: 22 May 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».