Endoscopic resection of a giant Brunner’s gland adenoma of the duodenum: clinical case

Brunner’s gland adenoma (brunneroma) is a rare benign duodenal lesion originating from the submucosal Brunner’s glands. In most cases, it is asymptomatic and incidentally detected during endoscopy. However, when large in size, it may present with clinical symptoms, including epigastric discomfort, anemia, and signs of gastrointestinal obstruction. Optimal management strategies, particularly for giant brunneromas, remain a subject of ongoing debate. Objective: To present a clinical case of a giant Brunner’s gland adenoma and to evaluate diagnostic approaches and the feasibility of endoscopic treatment. Clinical case. A 37-year-old female presented with epigastric pain and a sensation of postprandial fullness. Upper endoscopy revealed a subepithelial lesion of the duodenal bulb measuring up to 5 cm, prolapsing into the gastric lumen. Endoscopic ultrasound confirmed its submucosal origin and structural characteristics. Histology demonstrated an intestinal-type adenoma with focal low-grade dysplasia. The patient underwent endoscopic piecemeal snare resection. The total size of the resected specimen was approximately 7 cm. The postoperative course was uneventful. Follow-up endoscopy at 4 months showed no evidence of recurrence. Conclusion. This case highlights that endoscopic piecemeal resection may represent an effective and safe treatment option for giant Brunner’s gland adenomas. Advanced endoscopic techniques, including endoscopic ultrasound, enable precise lesion characterization and facilitate optimal therapeutic decision-making. Early removal of such lesions is justified given the risk of complications and potential for dysplastic changes.