Five duodenal strictures

Just another piece of fun ☺!  Here are 5 photographs of duodenal strictures, each of a different aetiology! 
CAN YOU MATCH THE STRICTURE WITH THE PHOTO?

■ NSAID induced stricture =

Photograph D

■ Peptic stricture =

Photograph A

■ Chronic pancreatitis =

Photograph E

■ Chrohn's disease =

Photograph B

■ Duodenal adenocarcinoma =

Photograph C

EXPLANATION

You'll know that NSAID induced strictures are classically 'membrane-like' as in Photograph D. 

The 'Peptic stricture' is shown in photograph A.  The healed duodenal ulcer had been at 9 O'clock in that stricture.  

Chronic pancreatitis causes external compression of D1 or D2 usually with swollen villi. Of course there are two photographs to choose between - Photo C or E.  Lets leave that one and see if the Crohn's stricture is easier to find.

Of course, photograph B shows ulceration and inflammation and must be the CD stricture. 

That leaves the malignant stricture which could be photograph C or E.  It's usually relatively easy to squeeze past the external compression caused by a swelling in the head of the pancreas. In contrast, malignant duodenal strictures are usually impassable. Which one looks the tightest?  Photo C or E?  Well, C is the malignant stricture which I had to dilate up to 10mm before I could take samples a little deeper into the stricture to confirm the diagnosis.  Photograph E was a case of severe pancreatitis which we scoped as he had dropped his Hb (never found out why or how).