Giant bleeding duodenal bulb adenoma: pedunculated morphology favors en bloc snare resection

A 38-year-old man presented with a 5-day history of melena and progressive fatigue. Laboratory testing showed severe iron-deficiency anemia, with a hemoglobin level of 66 g/L, serum iron level of 2.1 μmol/L, and ferritin level of 9 ng/mL. Upper gastrointestinal endoscopy revealed a 5.0 × 2.0 cm pedunculated, ulcerated lesion occupying the duodenal bulb, with surface bleeding. Its pedunculated morphology and clearly identifiable stalk made en bloc snare resection technically feasible.