Ischemic treatment of the duodenal windsock web using the ultra-thin endoscope, with modified detachable snares
Bibliographic record
Abstract
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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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 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".