PMC2773429_01
(a) Endoscopic view of the duodenum. Upper GI endoscopy revealed elevated white nodules in the second part of the duodenum. (b) Double-balloon endoscopic view of the jejunum. Double-balloon endoscopy showed multiple nodular lesions and elevated white patches in the jejunum. (c) FICE view of the jejunum. FICE showed whitish small nodules in the jejunum.
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fig1
Upper gastrointestinal endoscopy revealed white elevated nodules in the second part of the duodenum (Figure 1(a)). D1 on immunohistochemical staining. Double-balloon endoscopy showed multiple nodular lesions and elevated white patches from the jejunum up to the terminal ileum, with the majority of lesions concentrated around the proximal part of the ileum (Figure 1(b)). Fuji Intelligent Chromo Endoscopy (FICE) (EG590-ZW, Fujinon Toshiba ES Systems, Tokyo, Japan) revealed small, whitish nodules in the jejunum (Figure 1(c)).
PMC2773429_02
(a) Endoscopic view of the duodenum. Upper GI endoscopy showed multiple polypoid lesions in the duodenum. (b) NBI view of the duodenum. NBI demonstrated a coiled, elongated vascular pattern within elevated lesions of the duodenum. (c) Double-balloon endoscopic view of the jejunum. Double-balloon endoscopy showed multiple polypoid lesions in the jejunum.
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fig2
Case 2 was a 66-year-old male who was found to have multiple polypoid lesions in the duodenum on routine surveillance endoscopy (Figure 2(a)). Narrow-band imaging (NBI) (H260Z, Olympus, Tokyo, Japan) demonstrated a coiled, elongated vascular pattern within elevated lesions of the duodenum (Figure 2(b)). Subsequent double-balloon endoscopy showed multiple polypoid lesions involving the second and third parts of the duodenum and the proximal part of the jejunum (Figure 2(c)).
PMC2773429_03
(a) Endoscopic view of the duodenum. Upper GI endoscopy showed a few scattered white polypoid lesions and a few isolated nodular lesions in the duodenum. (b) NBI view of the duodenum. NBI demonstrated a mildly elongated vascular pattern within elevated lesions of the duodenum. (c) Double-balloon endoscopic view of the jejunum. Double-balloon endoscopy showed scattered white polypoid and nodular lesion in the jejunum.
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fig3
Case 3 is a 48-year-old asymptomatic male in whom a few scattered white polypoid lesions and a few isolated nodular lesions in the duodenum were identified during routine annual surveillance (Figure 3(a)). NBI demonstrated a mildly elongated vascular pattern within elevated lesions (Figure 3(b)). Subsequent double-balloon endoscopy showed scattered white polypoid and nodular lesions in the third part of the duodenum and the proximal part of the jejunum that were similar to the lesions observed in the second part of the duodenum (Figure 3(c)).