Work

Endoscopic submucosal dissection in the management of bleeding duodenal tumors refractory to conventional therapy

Year: 2025

Type: article

Abstract: Background and Aims: Although isolated hamartomas are rare, they can cause bleeding that is refractory to medical treatment. Management strategies depend on factors such as tumor location, size, and bleeding intensity. Methods: A 94-year-old woman experienced melena and a significant decrease in hemoglobin from 13 g/dL to 7 g/dL. An EGD revealed a large, bleeding pedunculated tumor in the duodenum. Previous interventions, including epinephrine injection and EMR, failed, necessitating multiple blood transfusions. After multidisciplinary consultation, endoscopic submucosal dissection was undertaken. Results: En bloc resection of the duodenal lesion was performed successfully. The specimen was segmented and removed without causing any trauma to the duodenal wall. Conclusions: Hamartomas in the upper GI tract, particularly in the stomach or duodenum, pose a greater bleeding risk. Endoscopic submucosal dissection effectively removes large duodenal tumors, especially when EMR is unfeasible. Segmenting the specimen during retrieval minimizes trauma to surrounding tissue, preserving duodenal integrity.

Source: VideoGIE

DOI: 10.1016/j.vgie.2025.03.036

Authors: Daryl Ramai, Abdulrahman Qatomah, Marvin Ryou, Christopher C. Thompson, Hiroyuki Aihara

Institutions: Brigham and Women's Hospital, Harvard University

Language: English

Topic: Gastrointestinal Bleeding Diagnosis and Treatment

Subfield: Gastroenterology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,000