A giant Brunner’s gland hamartoma being treated as a pedunculated polyp: a case report

Abstract

Background With the development and application of endoscopic technology, most pedunculated polyps can be absolutely resected with a complete specimen by hot snare polypectomy (HSP). Brunner’s gland hamartoma (BGH) is a rare benign small bowel tumor. The majority of BGH measuring about 2 cm in diameter, rarely larger than 5 cm. Most patients are asymptomatic, some may present with gastrointestinal hemorrhage or intestinal obstruction. Symptomatic larger lesions leading to bleeding or obstruction should be excised either endoscopically or surgically. Whether it is safe and effective that removing a BGH measuring about 7 cm by HSP is not known. Case presentation Here, we reported a rare case of a proximal duodenum pedunculated mass measuring about 7 cm which was responsible for the patient’s severe anemia. we treated it as a pedunculated polyp. After being pretreated the stalk with an endoloop which was placed around the base of the mass to prevent post-polypectomy bleeding (PPB), the pedunculated BGH was removed by HSP completely. The stalk of the mass was negative. We achieved a curative resection. Conclusion It is a safe and effective for our patient to treat the pedunculated BGH measuring about 7 cm as a pedunculated polyp and remove it by HSP. And future prospective studies in larger cohorts are needed to confirm it.

A giant Brunner gland hamartoma successfully treated by endoscopic excision followed by transanal retrieval

“…BGH can be treated either by endoscopic or surgical excision, for large BGHs, however, surgical resection might be selected because of its ease and safety. Recently, Yi et al [ 8 ] reviewed 35 cases of giant BGHs from the literatures and their own case. In these cases, all the exophytic BGH and sessile BGH were removed surgically, while endoscopic resection was performed in the pedunculated BGH.…”

“…Larger BGHs have been generally treated by surgical intervention, [ 5 , 6 ] while some lesions have been treated by endoscopic resection despite its larger size. [ 7 , 8 ] Achievement of en bloc specimen would be important for histological confirmation of BGH, however, in larger lesions, transoral retrieval of the resected specimen may be difficult because of its size. Here, we report a BGH measuring about 5.5 cm in proximal duodenum, successfully treated by endoscopic excision followed by transanal retrieval.…”

Brunner’s glands hamartoma with pylorus obstruction: a case report and review of literature

“…Thus, considerable confusion and overlapping in the diagnosis exist and accurate estimation of the prevalence of these lesions is difficult. Generally, BG hyperplastic polyps are small (0.5–2.0 cm), asymptomatic, can be multiple and discovered incidentally during endoscopic examination, while BGH are usually solitary and larger (>2 cm) [ 5 ].…”

“…Benign proliferative lesions of the BG account for 5–10% of all benign duodenal masses and less than 1% of all gastrointestinal tumors [ 4 ]. These lesions are often identified incidentally during endoscopy, can be intraluminal or polypoid/exophytic, sessile or pedunculated and can be treated by endoscopic or surgical resection [ 5 ]. The diagnosis of BGs proliferative lesions is usually straightforward.…”

Endoscopic resection of a duodenal Brunner gland hamartoma presenting with GI bleeding

“… 1 , 2 Most of these lesions are between 2 and 5 cm, and the majority of symptomatic cases present with either bowel obstruction or GI bleeding as a result of superficial erosions and ulceration. 3 Diagnosis usually requires deep tissue biopsy with EUS for histopathologic evaluation. EUS also provides information about the depth of involvement and any associated submucosal vasculature.…”