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. 2021 Jan 1;9(1):E58–E65. doi: 10.1055/a-1293-7487

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The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

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Fig. 3 — A case of duodenal adenoma without biopsy. a Endoscopic findings using conventional endoscopy with white light imaging. A whitish, slightly depressed lesion (10 mm in diameter) is seen in the second part of the duodenum b Endoscopic findings using magnifying endoscopy with narrow-band imaging (M-NBI). A clear demarcation line is identified according to the distinct differences in microsurface (MS) pattern between the lesion and the background mucosa. Vessel plus surface (VS) classifications: V, Because of the presence of white opaque substance (WOS), the morphology of the subepithelial microvessels cannot be observed, making this an absent microvascular (MV) pattern. S, The WOS has a regular mazelike pattern with a symmetrical distribution and regular arrangement. Thus, this lesion was graded as a regular MS pattern using WOS as a marker for the MS pattern. The VS classification of this lesion was absent MV pattern plus regular MS pattern (WOS +) with a DL. Therefore, the M-NBI diagnosis was non-malignant. c The final histological diagnosis was low-grade adenoma.