Endoscopic submucosal dissection of duodenal Brunner's gland mass using transpyloric traction wire fixation.

Background and Aims: Brunner's gland proliferative lesions, including adenomas and hamartomas, are rare benign duodenal tumors that can cause upper gastrointestinal symptoms when large. Endoscopic submucosal dissection (ESD) in the duodenum is technically challenging because of limited maneuverability and thin wall anatomy. Careful planning of the incision line is crucial for safe resection and effective closure. This case illustrates a traction wire-assisted transpyloric fixation technique designed to improve visualization and stability during ESD. Methods: A patient with a symptomatic, pedunculated Brunner's gland lesion of the duodenum underwent ESD using a traction wire. The distal tip of the lesion was advanced into the stomach, clipped, and anchored to the gastric wall to provide countertraction and expose the submucosal plane for controlled dissection. Results: En bloc resection was achieved successfully. The traction method maintained continuous visualization of the lesion base, enabling precise submucosal dissection and secure closure of the mucosal defect with clips. The patient recovered uneventfully, and preprocedural symptoms resolved completely. Histopathology confirmed Brunner's gland proliferation. Conclusions: Traction wire-assisted transpyloric fixation during duodenal ESD improves exposure and procedural stability, facilitating safe and effective resection of large Brunner's gland lesions with favorable clinical and endoscopic outcomes.