Makazu M, Sasaki A, Ichita C, Sumida C, Nishino T, Nagayama M, Teshima S. Giant Brunner's gland hyperplasia of the duodenum successfully resected en bloc by endoscopic mucosal resection: A case report. World J Gastrointest Endosc 2024; 16(6): 368-375 [PMID: 38946860 DOI: 10.4253/wjge.v16.i6.368]
Corresponding Author of This Article
Makomo Makazu, MD, PhD, Doctor, Staff Physician, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Japan. m_makazu@shonankamakura.or.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Makomo Makazu, Akiko Sasaki, Chikamasa Ichita, Miki Nagayama, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
Chihiro Sumida, Takashi Nishino, Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Shinichi Teshima, Department of Pathology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
Author contributions: Makazu M participated in conceptualization of the manuscript and collection of data and wrote the manuscript; All authors revised and approved the revised version.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Makomo Makazu, MD, PhD, Doctor, Staff Physician, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Japan. m_makazu@shonankamakura.or.jp
Received: April 6, 2024 Revised: April 30, 2024 Accepted: May 21, 2024 Published online: June 16, 2024 Processing time: 69 Days and 3.4 Hours
Abstract
BACKGROUND
Duodenal Brunner's gland hyperplasia (BGH) is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out. Herein, we present a case of large BGH treated with endoscopic mucosal resection (EMR).
CASE SUMMARY
An 83-year-old woman presented at our hospital with dizziness. Blood tests revealed severe anemia, esophagogastroduodenoscopy showed a 6.5 cm lesion protruding from the anterior wall of the duodenal bulb, and biopsy revealed the presence of glandular epithelium. Endoscopic ultrasonography (EUS) demonstrated relatively high echogenicity with a cystic component. The muscularis propria was slightly elevated at the base of the lesion. EMR was performed without complications. The formalin-fixed lesion size was 6 cm × 3.5 cm × 3 cm, showing nodular proliferation of non-dysplastic Brunner's glands compartmentalized by fibrous septa, confirming the diagnosis of BGH. Reports of EMR or hot snare polypectomy are rare for duodenal BGH > 6 cm. In this case, the choice of EMR was made by obtaining information on the base of the lesion as well as on the internal characteristics through EUS.
CONCLUSION
Large duodenal lesions with good endoscopic maneuverability and no evident muscular layer involvement on EUS may be resectable via EMR.
Core Tip: This is a report of a large Brunner’s gland hyperplasia in an older female patient with anemia that was successfully resected en bloc using endoscopic mucosal resection (EMR). After obtaining information on the base of the lesion as well as on the internal characteristics using endoscopic ultrasonography, we chose EMR as a minimally invasive treatment.
