Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2024; 16(6): 368-375
Published online Jun 16, 2024. doi: 10.4253/wjge.v16.i6.368
Giant Brunner's gland hyperplasia of the duodenum successfully resected en bloc by endoscopic mucosal resection: A case report
Makomo Makazu, Akiko Sasaki, Chikamasa Ichita, Chihiro Sumida, Takashi Nishino, Miki Nagayama, Shinichi Teshima
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.

Keywords: Duodenum, Brunner’s gland hyperplasia, Brunner’s gland hamartoma, Brunner’s gland adenoma, Endoscopic mucosal resection, Case report

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.