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Online health information about CRC screening tools are written at higher levels than the National Institute of Health (NIH) and American Medical Association (AMA) recommended third to seventh grade levels. More patients could benefit from this modality of information if it were written at a level and quality that would better facilitate understanding.

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Gastric intramural hematoma (GIH) is a rare disorder that usually arises secondary to another condition or intervention, and less often occurs without an identifiable cause. Computed tomography (CT), as performed in this case, is the diagnostic modality of choice. The treatment comprises conservative measures, a minimally invasive approach, or surgical intervention. We present a case of recurrent acute lymphoblastic leukemia (ALL) as a new etiology for GIH that was managed conservatively to highlight the importance of including GIH in the differential for a patient with ALL, a drop in hemoglobin level, and vague gastrointestinal symptoms.

help of endoloop placement followed by electrocautery-assistant resection and endoclip placement to close the resected area. The patient tolerated the procedure well without any consequence. Histopathology of the mass showed hyperplasia of Brunner's glands. Follow up endoscopy at 6 month revealed healed scar at the resected site without any endoscopic evidence of recurrence. Discussion: Brunner's gland hamartoma is an extremely rare duodenal tumor with an estimated incidence of 0.008%. The name arises from the Brunner's glands which are acinotubular glands that secrete alkaline fluid. The majority of patients are asymptomatic and have an incidental finding from the imaging or EGD. Patients commonly present with gastrointestinal bleeding and obstructive symptoms. EGD finding usually reveal a pedunculated mass 1-2cm in size located at duodenal bulb area consistent with Brunner's gland distribution. The diagnosis relies on endoscopic finding and imaging. The pathology of the tissue yields the definitive diagnosis. Often this polyp develops into thick wide stalk which may contains large blood vessel; EUS should be performed to assess the lesion as well and its vascularity. Endoloop placement prior to EMR should help prevent significant bleeding during the resection of the lesion as described in our case. Malignant potential has been reported to be extremely rare, but dysplastic changes and invasive carcinoma can be seen. (Figure). [2570] Figure 1. (A) Endoscopic view of a large pedunculated polyp at the duodenal bulb (B) Endosonographic view (white arrow) of the lesion at the duodenal bulb (C) Histopathology (H&E stain) shows hyperplasia of the Brunner's glands (D) Gross specimen of the mass measuring 3cm in size.