• Motonobu Maruo, Tomomitsu Tahara, Fumihiro Inoue, Takeshi Kasai, Natsuko Saito, Kazunori Aoi, Masahiro Takeo, Kimi Sumimoto, Masao Yamashina, Miki Murata, Masanori Koyabu, Takahiro Wakamatsu, Noriyo Yamashiki, Akiyoshi Nishio, Kazuichi Okazaki, and Makoto Naganuma.
• Third Department of Internal Medicine, Kansai Medical University.
• Medicine (Baltimore). 2021 Apr 9; 100 (14): e25048e25048.

RationaleBrunner gland hamartoma (BGH) is a rare tumor of the duodenum. Although BGH is a benign tumor, larger lesion with gastrointestinal symptoms requires tumor removal. We report a giant BGH, successfully treated by endoscopic excision followed by transanal retrieval.Patient ConcernsA 38-year-old woman complained of severe anemia, tarry stool, and vomiting.DiagnosesEsophagogastroduodenoscopy (EGD) showed a pedunculated giant submucosal mass at the duodenal bulb.InterventionsWe attempted to remove it because the lesion seemed to be responsible for patient's anemia and vomiting. The lesion had clear but bulky stalk. We carefully cut the stalk using needle-knife and IT knife2. We tried to retrieve specimen, but the mass could not pass through the pyloric ring because of its size. Then we tried to obtain the specimen from anus. Polyethylene glycol solution was administered to accelerate rapid excretion.OutcomesThe mass was successfully removed and was histologically confirmed as a giant BGH, measuring 55 mm in size.LessonsReports about endoscopic resection of giant BGH are rare. Moreover, our case is the first report of transanal retrieval of resected specimen using polyethylene glycol solution. Endoscopic resection of BGH is less-invasive but can be more challenging if the mass is large. Our case provides useful option for endoscopic treatment of giant BGH.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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