Question: An 84-year-old woman presented to the endoscopy department for elective esophagogastroduodenoscopy owing to vague upper abdominal complaints. After passage through the pylorus, the distal duodenal bulb revealed a second lumen arising from the anterior aspects of the distal bulb (Figure A), which was easily intubated by the standard endoscopy used (Olympus, GIF H180, Hamburg, Germany; outer diameter 9.8 mm).