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

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.