Dual Transoral Endoscopic Resection of a Symptomatic Giant Brunneroma

Brunneroma is a rare, benign, proliferative lesion arising from the Brunner's glands of the duodenum that exceptionally may evolve towards a malignant transformation, usually discovered incidentally at endoscopy. Occasionally, these lesions manifest as a rare cause of duodenal obstruction or upper gastrointestinal bleeding and require resection, usually for tumors larger than 4 cm. The special aspect of our case is the technically difficult but successful dual transoral endoscopic resection of a giant (6.5 × 4 × 2.4 cm) brunneroma with a very thick and long peduncle located extremely close to the pylorus, highlighting the possibilities of endosurgery. Distal stomach resection with Roux-en-Y reconstruction as an alternative would have caused higher morbidity and costs.