Gel immersion endoscopic mucosal resection for pedunculated Brunner's gland hyperplasia in the duodenal bulb near the pylorus

Brunner’s gland hyperplasia is a benign tumor that occurs primarily in the duodenal bulb. Endoscopic resection is indicated when there is bleeding, obstructive symptoms, or the lesion is large and malignancy cannot be ruled out [1]. Conventional endoscopic mucosal resection (EMR) for the resection of Brunner’s gland hyperplasia has been reported [2] [3]. However, conventional EMR of large Burner’s gland hyperplasia in the duodenal bulb is often difficult because the space is narrowed by local injection, reducing visibility and maneuverability. Underwater EMR may be an effective method [4], but it is often difficult to secure the visual field owing to poor saline retention in the duodenal bulb near the pylorus. Gel immersion EMR (GI-EMR) has recently been reported for duodenal tumors [5]. Here we report the usefulness of GI-EMR in the duodenal bulb near the pylorus for pedunculated Brunner’s gland hyperplasia.