Practical Status of Endoscopic Duodenal Observation and Clinical Relevance of Systematic Photo-Documentation Protocol: A Questionnaire Survey

Introduction: Early detection of duodenal neoplasms is crucial because of the complications associated with their treatment and their increasing recognition. However, standardised protocols for duodenal observation during screening esophagogastroduodenoscopy (EGD) have not been established. This study was performed to survey the current practical status of duodenal observation and to evaluate the clinical relevance of our systematic photo-documentation protocol, known as the Seven Pictures Rule (7PR). Methods: A cross-sectional survey using a web-based self-administered questionnaire was conducted among endoscopists in a regional area of Japan. The questionnaire included items on respondents’ professional background, duodenal observation practices during screening EGD (observed locations, observation time, ampulla visualization, and patient discomfort), as well as awareness, application, and perceived effects of the 7PR, and preferences for future protocols. Data were anonymized and analyzed descriptively. Results: Of the 99 endoscopists included, 96.7% reported observing the duodenum based on their own individual methods. The intentional observation rates by location were highest in the following order: bulb (99%), ampulla in descending (94%), contralateral ampulla in descending (84%), superior duodenal angle (77%), contralateral superior duodenal angle (79%), and transverse duodenum (33%). However, only 14% of respondents reported successfully observing the ampulla in more than 75% of cases. While 62% were aware of the 7PR, only one-fourth had implemented it in practice. Notably, 43% of respondents familiar with the 7PR felt that it had led to an increased detection of duodenal neoplasms. Conclusions: Current duodenal observation practices vary among endoscopists. The establishment of a systematic photo-documentation protocol such as the 7PR may serve as a useful strategy for improving the detection of duodenal neoplasms. Further optimisation of the protocol is warranted to support broader adoption in clinical settings.