Endoscopic diagnosis of duodenal neoplasms causing upper gastrointestinal bleeding

Duodenal neoplasms are a rare and not often considered cause of massive upper gastrointestinal bleeding. During a 4-year period, 859 endoscopies in patients with upper gastrointestinal bleeding revealed a duodenal tumor to be the cause of bleeding in eight patients. Three patients had a primary duodenal neoplasm, two had metastatic involvement, and in three others pancreatic tumors had invaded the duodenum. In view of our findings, we recommend careful endoscopic scrutiny of all parts of the duodenum in patients with upper gastrointestinal bleeding especially when the cause of bleeding is not found in the esophagus, stomach, or duodenal bulb.