[Differential diagnosis of tumors of the duodenal bulb by endoscopy and biopsy (author's transl)].

Duodenoscopy was performed in 2 602 patients; malignant tumors were found in 5, hyperplasia of Brunner's glands in 5, hyperplasia of lymphatic follicles in 26, inflammatory pseudo-polyps in 9, and ectopic gastric mucosa in 5 cases. Only 3 of the big tumors had been detected by x-ray examinations; enlarged lymphatic follicles and the polyps had escaped x-ray detection altogether. Infiltration of the mucosa by tumor tissue can be suspected merely on the ground of endoscopic inspection with a high degree of probability. Histological diagnosis depends on forceps biopsy. Big particle biopsy of submucosal tumors with a sling carries a high risk, which however has to be taken in order to obtain a definite diagnosis. Tumors of the duodenal bulb caused by inflammatory processes do present considerable diagnostic problems. Special problems of diagnosis and therapy of the cases presenting with hyperplasia or adenoma of Brunner's glands are discussed in a special section.