Role of esophagogastroduodenoscopy in detecting distal duodenal lesions: a single-center pilot study in South China

Objective Esophagogastroduodenoscopy (EGD) is the standard instrument to detect diseases of the upper digestive tract. However, the deep areas of the duodenum are often missed. This study aimed to clarify the diagnostic role of EGD in the distal duodenum. Methods This retrospective study enrolled 63 patients with distal duodenal lesions between January 2004 and July 2016. Rate of missed diagnosis on EGD examination was calculated. Logistic regression analysis was performed to identify factors associated with missed diagnosis. Results A total of 63 patients were included. Overall diagnostic rate of distal duodenal lesions on EGD was 58.7%. After excluding patients in whom EGD did not reach the distal duodenum, this rate was 82.2%. In univariate analysis, intravenous sedation (26.8% vs 68.2%; odds ratio [OR], 0.171; P = 0.002), sign of lesions next to stomach (19.4% vs 62.5%; OR, 0.099; P = 0.001), prior enteroscopy experience (15.0% vs 87.0%; OR, 0.026; P < 0.001), and endoscopy experience of more than 10 years (13.8% vs 64.7%; OR, 0.087; P < 0.001) were associated with decreased risk of missed diagnosis. In multivariate analysis, sign of lesions next to stomach (OR, 0.167; P = 0.039) and prior enteroscopy experience (OR, 0.035; P < 0.001) were significant independent protective factors. Conclusion EGD could have important diagnostic value for the distal duodenum. Patients with gastric retention, bloodstain in the stomach, or erosion in the proximal duodenum may benefit from the deep insertion of EGD. Copyright © 2017 John Wiley & Sons, Ltd.