Novel endoscopic duodenal observation protocol based on Seven Pictures Rule for detecting duodenal neoplasms during esophagogastroduodenoscopy: Prospective observational study

ObjectivesNo protocol for esophagogastroduodenoscopic examination of the duodenum has been established. We examined the feasibility and ability to detect neoplasms of a novel duodenal examination protocol. MethodsThis was a two-facility, prospective, observational study. Our protocol, the Seven Pictures Rule (7PR), requires pictures of the following seven locations: anterior and posterior to the bulb, area of and contralateral to the superior duodenal angle, area of and contralateral to the ampulla, and the transverse duodenum. The primary outcome was rate of completion of 7PR. Secondary outcomes were overall rates of detecting neoplasms, rates of detecting neoplasms for each location, examination time, and completion rates for standard or ultrathin endoscopes. ResultsThere were 1549 participants. The 7PR completion rate was 81.1% and the detection rates of overall neoplasms, adenomas, and carcinomas were 0.84%, 0.71%, and 0.06%, respectively. The area in which most neoplasms was detected was contralateral to the ampulla (69.2%), and the fewest the transverse duodenum (0%). Mean duration of duodenal examination was 53.1 s. Completion rates for standard vs. ultrathin were 84.4% (1077/1276) vs. 65.6% (179/273) (P < 0.01), respectively. ConclusionsSeven Pictures Rule is acceptable for duodenal examination and a potential quality indicator.

Automated summary

This study established a new duodenal examination protocol called the Seven Pictures Rule (7PR), and investigated its feasibility and ability to detect neoplasms. The results showed that the completion rate of 7PR was 81.1%, and the overall detection rates of neoplasms, adenomas, and carcinomas were 0.84%, 0.71%, and 0.06% respectively. Most neoplasms were detected contralateral to the ampulla (69.2%), and the fewest were found in the transverse duodenum (0%). The completion rates for standard and ultrathin endoscopes were 84.4% and 65.6% respectively.