Post written by Tara Keihanian, MD, MPH, and Sunil Amin, MD, MPH, from the Department of Medicine, Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, Florida.

A 64-year-old man with multiple comorbidities presented to our hospital with a 3-day history of weakness, melena, and acute anemia. Upper endoscopy (EGD) showed a large submucosal duodenal mass arising from the distal bulb to second portion of the duodenum without ampullary involvement. Endoscopic ultrasound (EUS) was remarkable for a 3.5-cm submucosal polypoid, ulcerated mass with a broad-based stalk in the duodenal bulb prolapsing into the distal duodenum. Both mucosal biopsies and EUS-FNB confirmed Brunner’s gland hamartoma without evidence of dysplasia. Given the symptomatic nature of the lesion, the decision was made to proceed with endoscopic resection. A large endoloop was maneuvered over the stalk and closed at the base, followed by injection of epinephrine into the stalk. A 30-mm standard stiffness snare was then placed successfully over the endoloop using a forward viewing and side-viewing gastroscope, and the resection was completed. A small part of the polyp was deliberately left behind above the endoloop to minimize the risk of perforation as well as bleeding, as the endoscopic objective was not to achieve complete enbloc resection but rather cessation of GI bleeding. The patient did well post procedure, with no adverse events or further episodes of melena.

Although, diagnosis of Brunner gland hamartoma requires histopathological confirmation, EUS can provide crucial information about the depth of involvement and any associated submucosal vasculature.

In comparison to surgical resection, endoscopic resection appears to be safer and less invasive. Our case highlights the fact that endoscopic resection is usually a safe and easy approach for management of symptomatic Brunner’s gland hamartomas.

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