Endoscopic Resection of a Bleeding Brunnerʼs Glands Hamartoma
Bibliographic record
Abstract
Brunner's glands hamartoma is a rare and benign lesion arising from the brunner's glands of the duodenum. This proliferation can be symptomatic with bleeding or obstruction, rarely with chronic pancreatitis. Around 200 cases have been reported and tumors are rarely more than 5 cm. A 81 years-old lady known for gastroeosophageal reflux on proton pump inhibitor and a 28x18 mm pedunculated submucosal lesion (hyper echoic with small hypo echoic foci) of the duodenum which was stable in appearance and size in 2009 presented with a 5 days history of melena with abdominal discomfort. Her blood work was remarkable for haemoglobin of 64 g/L (127 g/L previously).Figure 1The upper endoscopy showed a more than 5 cm duodenal polyp with multiples ulcerations and friability without active bleeding. Placement of a ligating device to prevent the rebleeding, polyloop 30mm (Olympus: HX-400U-30), was impossible due to the size and position of the lesion. A CT-scan confirmed a polypoïd lesion anchored in the duodenal bulb without extra digestive extension of suspicious ganglion. An endoscopic ultrasonography showed a more than 4x3 cm lesion of the duodenal bulb with a relatively short and thick peduncle originating from the mucosa with complete sub mucosa infiltration. This lesion was diffusely homogenous with a hyper echoic pattern. There was no muscular layer infiltration. Considering the advanced age of the patient an endoscopic resection was considered acceptable. A second endoscopy was performed. An « en bloc » resection with a 3x6 cm Acusnare polypectomy snare (Cook Medical: ASJ-1-S: G22630) at the base of the peduncle. The polyp was displaced in the stomach with some resistance and an arterial bleeding from the base of the polypectomy was control with a Resolution Clip (Boston Scientific: 2261). Two other clips were installed and a polyloop 30 mm surrounding the clips closed the mucosal defect. The polyp was then grabbed with the snare but was too big to pass the gastro oesophageal junction. We unsuccessfully tried to cut the polyp in two pieces. A 16.7 mm inner diameter 50 cm length Guardus gastric overtube (USEndoscopy: BX00711149) was placed in the stomach. The polyp was grabbed again with the snare and impacted 50% of its length in the distal portion of the overtube. All items (polyp, scope, overtube) were removed « en bloc » without much resistance. Pathology showed a 5.5x4x2.2 cm lesion with a 1.2x2 cm insertion site considered a brunner's glands hamartoma without dysplasia with multiple superficial ulcers. The resection was incomplete with lesion at the insertion site. The patient had no complication or further bleeding and was discharged home. A six months follow-up upper endoscopy is pending.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".