World Congress of Gastroenterology

WCOG 2019


 
Successful Cap-Assisted Endoscopic Resection of a Large Brunner’s Gland Hamartoma Closed with an Over-the-Scope Clip
ENRIK JOHN AGUILA 1 RACHEL MARIE CRUZ 1 JONARD CO 1

1- ST. LUKES MEDICAL CENTER, GLOBAL CITY, PHILIPPINES
 
Abstract:

Brunner’s gland hamartoma is a rare benign tumor of the duodenum formed from a proliferation of Brunner’s glands. It is usually an incidental finding but can also be an unusual cause of obstruction or bleeding, requiring endoscopic or surgical resection. This is a case of a 53-year-old male presenting with gastrointestinal bleeding with a noted large duodenal polyp on gastroscopy. The lesion was successfully resected via endoscopic mucosal resection (EMR) with the defect closed by an over-the-scope clip. 

This is a case of a 53-year-old male who presented with a five-day history of melena for which he underwent blood transfusions. Prior to the episodes of GI bleeding, he was maintained on an anticoagulant for deep vein thrombosis. He underwent gastroscopy which showed a pedunculated polypoid lesion around 3-4 cm at the duodenal bulb with an ulceration at its distal tip but no active bleeding. To further probe on the nature of the lesion, an endoscopic ultrasound was done which showed a 22 x 10mm hypoechoic lesion confined to the mucosa and submucosa. Patient eventually underwent cap-assisted EMR. Submucosal injection with saline and adrenaline was done at the base for hemostatic control and after adequate lift, EMR was performed using a 25mm snare. The resultant defect was closed using a 9mm over-the-scope (Ovesco) clip. Patient noted resolution of symptoms. Histopathology eventually revealed brunner’s gland hamartoma with focal ulceration. A repeat gastroscopy 3 months after showed an intact post-resection site with the Ovesco clip still in place.

This case report shows a successful resection of a rare Brunner’s gland hamartoma via an advanced endoscopic and hemostatic technique. While surgery has been the usual treatment if patients are already symptomatic, it is important to take into consideration that endoscopic resection has nowadays been an acceptable and less invasive option with good clinical outcomes.

Keywords:

 brunners gland, hamartoma, over-the-scope clip, EMR