This was an incidental finding in the duodenal cap in a patient undergoing gastroscopy to investigate reflux symptoms. Although samples only showed a normal duodenal mucosa the patient was referred for an endoscopic resection. The lesion is soft to the touch.
WHAT WOULD YOU DO NEXT?
■ Abort this is nothing!
■ Attack, this is something!
No it isn't !
This is exactly what happened ! The 'lesion' was soft to the touch and previous samples had not revealed any abnormality. Of course a Brunner's gland hyperplasia could be a possibility but the fold was too soft and in any event, these don't need to be removed! On the other hand, the patient was standing in the endoscopy room expecting his 'lesion' to be removed, to 'find out what it is! '
At times you may feel that you are 'put on the spot' in endoscopy, being asked to do things which you don't agree with or perhaps procedures you don't feel qualified to carry out unsupervised.
Of course, you are more than a 'technician' and it's your duty to do what's best for the patient. That patient is 'your patient' in the endoscopy unit and should something go wrong, you'll have to take full responsibility. Don't let yourself be pushed around by either the patient or his physician. "I was just following orders" doesn't wash if there is a complaint !
Anyway, I diagnosed an 'odd looking but entirely innocent duodenal fold', took another couple of biopsies (to calm things down) and reassured the patient !