Endoscopic Treatment of a Duodenal Duplication Cyst
Bibliographic record
Abstract
A 23-year-old Caucasian woman underwent investigations for symptoms of epigastric pain and gastroesophageal reflux. She was treated with a proton pump inhibitor for a few months without any improvement in symptoms. Abdominal computed tomography and endoscopic ultrasound examination revealed a paraduodenal cystic lesion on the antimesenteric side of the second part of the duodenum. This lesion was echo-poor, was more than 6 cm in length, and was composed of multiple layers similar to those of the intestinal wall. The diagnosis was a duodenal duplication. Examination with a side-viewing Olympus TJF-160 duodenoscope revealed a soft and depressible mass (Figure [ 1 ]). An incision was made with a needle-knife papillotome (Microknife XL; Boston Scientific Microvasive, Spencer, Indiana, USA) on the proximal, dependent portion of the cyst. The cyst was cannulated with a sphincterotome (Cotton Cannulatome II PC Double Lumen; Wilson-Cook Medical, Winston-Salem, North Carolina, USA). The incision was extended until an opening of 1.5 cm was obtained. One month later, a second endoscopy was performed and the duplication cavity was found to be totally collapsed. The previous incision was now about 2 cm long and was extended for another 1 cm (Figure [ 2 ]). One month after discharge, the patient was well and symptom-free. Figure 1 Endoscopic view of a bulging, depressible mass on the antimesenteric side of the second part of the duodenum. Figure 2 Endoscopic view at the second endoscopy, after extending the incision with a standard sphincterotome. Normal mucosa can be seen inside the duodenal duplication. Duodenal duplication is rarely diagnosed in adults. The most common clinical manifestations are intestinal occlusion, pancreatitis, perforation, or bleeding but symptoms can also be nonspecific, as in our patient [ 1 ]. Traditionally, duodenal duplication has been managed surgically and complete resection is the classic treatment. Only a few cases of endoscopic treatment of duodenal duplication have been reported [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Duodenal duplications are benign lesions, although two cases of malignant transformation have been reported in the literature, probably related to the presence of ectopic tissue inside the cyst, which was not found in our case [ 5 ] [ 6 ]. In conclusion, endoscopic treatment of duodenal duplication is an effective procedure which results in rapid relief of symptoms and avoids the morbidity associated with a laparotomy. Endoscopy_UCTN_Code_TTT_1AR_2AK
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".