Endosonographic Features of Brunner’s Gland Hamartomas Which Were Subsequently Resected Endoscopically

Abstract

Brunner's gland hamartoma is characterized endosonographically by a heterogeneous solid and/or cystic mass within the submucosa.

Saving from unnecessary pancreaticoduodenectomy. Brunner's gland hamartoma: Case report on a rare duodenal lesion and exhaustive literature review

“…Endoscopic ultrasound (EUS) is specifically useful in evaluating the extension, the morphological characteristics and the vascularity of the BGH. In 2002, Hizawa K. and colleagues studied the endosonographic features of BGH [16] in depth, demonstrating that there was a “heterogeneous solid or cystic mass within the submucosal layer” and highlighting the resection as the only possible tool to have a histological definition. To our knowledge, EUS plays the pivotal role in assessing the layer of origin, typically the submucosal layer.…”

Endoscopic Resection of a Pedunculated Brunner’s Gland Hamartoma of the Duodenum

“…On endoscopic ultrasonography, gangliocytic paragangliomas are typically seen as an isoechoic mass in the submucosal layer [20]. Hizawa et al reviewed the endoscopic ultrasonography features of six cases of Brunner's gland hamartoma and they noted that single or multiple cystic structures within the submucosa could be detected in four patients and solid echogenicity in the remaining two patients [10, 21]. Although the cystic structure may be found in the duodenum in association with Brunner's gland hyperplasia, duplication cyst, ectopic pancreas, central necrosis of gastrointestinal stromal tumor, pancreatic pseudocyst, and varices, these lesions do not present a pedunculated appearance.…”

Brunner’s Gland Hamartomas: Endoscopic Submucosal Dissection versus Snare Polypectomy

“…Because the lesions mostly appear as pedunculated submucosal tumors in the duodenal bulb [4,5], standard mucosal biopsies are of little benefit as in the patient of Ohba et al [1]. The hamartomas are usually discovered incidentally in asymptomatic patients, but can occasionally cause symptoms such as bleeding and obstruction [4].…”

“…In symptomatic patients, endoscopic or surgical resection is required [2]. Endoscopic polypectomy represents the ideal approach, and is more cost-effective and less invasive than surgery [5]. Reported endoscopic removal techniques include standard snare polypectomy [5], hemoclip-assisted polypectomy [2], injection and cutting [3], injection and interval polypectomy [4], and endolooping and polypectomy [6].…”

“…Based on the histological features of the hamartoma [4,10], the EUS appearance is characterized by an indistinct margin, hypoechogenicity, heterogeneous appearance, location within the second and third echolayers of the duodenal wall, and cystic areas within the lesion [5,10]. After EUS, the lesions can be safely removed endoscopically without complications [5,6].…”