Reviewer ’s report  
 
Title:  A Giant Brunner’s Gland Hamartoma being treated as a pedunculated polyp: a case report  
 
Version: 0 Date: 05 Jul 2019 
 
Reviewer:  Chih Wei  Tseng  
 
Reviewer’s report:  
 
This is an interesting case of a large Brunner's glang harmatoma  being treated as a pedunculated 
polyp with hard snare polypecto my. The authors concluded that the pedunculated large Brunner's 
glang harmatoma can be hard snare polypectomy with good safety.  
 
 
Major issues:  
 
Several reports disscues about the endoscopi c and surgical treatment for large Brunner's glang 
harmatoma. The recent work added few new information. They authors need to perform minimal 
review and disscue the difference between two methods ( including clinical outcomes, advance 
events, indications, and contraindications). How to determinate the right methods for the 
patients?  They need to summarize as a Table and updated the new reports as the report  of 
Frenkel (Hindawi Case Reports in Surgery Volume 2017, Article ID 6940649, 7 pages 
https://doi.or g/10.1155/2017/6940649  
 
In the past, the terms Brunner gland hyperplasia, Brunner gland hamartoma, and Brunner gland 
adenoma have been used interchangeably causing some confusion in the pathologic classification 
of these lesions.Brunner gland hyperplastic  polyps are usually small (0.5 cm -1.5 cm), 
asymptomatic, and discovered incidentally during upper endoscopy performed for other reasons. 
Brunner gland hamartomas are larger (.2 cm), and when symptomatic, present as gastrointestinal 
(GI) hemorrhage or intes tinal obstruction, often requiring endoscopic or surgical resection.The 
concept of Brunner gland adenoma is very contro - versial and still a matter of ongoing debate.In 
fact, prior reports of several large Brunner gland proliferative lesions without defini tive evidence 
of cytologic atypia that were reported as Brunner gland adenomas,5,7 in retrospect, represent 
examples of Brunner gland hyperplastic polyps or Brunner gland hamartomas. Brunner gland 
hyperplastic nodules/polyps and Brunner gland hamartomas ar e now believed to represent a 
morphologic continuum of benign hyperplastic/proliferative lesions of Brunner glands. As such, 
the term Brunner gland hyperplasia/hamartoma has been proposed for describing these 
nonneoplastic lesions.(Arch Pathol Lab Med. 201 9;143:370 -385; doi: 10.5858/ arpa.2018 -0034 -
RA) The authors need to check this with their pathologist.  
 
The authors believe that the endoscopic resection should been much safer if they  had performed 
a EUS(page 5 line 23 -25). Why ? The authors need to disc uss the importance of EUS.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in y our comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any w ay gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or sal ary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
I declare that I have no competing interests' below.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I ag ree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be inc luded in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  A Giant Brunner’s Gland Hamartoma being treated as a pedunculated polyp: a case report  
 
Version: 0 Date: 05 Jul 2019 
 
Reviewer:  Chih Wei  Tseng  
 
Reviewer’s report:  
 
This is an interesting case of a large Brunner's glang harmatoma  being treated as a pedunculated 
polyp with hard snare polypecto my. The authors concluded that the pedunculated large Brunner's 
glang harmatoma can be hard snare polypectomy with good safety.  
 
 
Major issues:  
 
Several reports disscues about the endoscopi c and surgical treatment for large Brunner's glang 
harmatoma. The recent work added few new information. They authors need to perform minimal 
review and disscue the difference between two methods ( including clinical outcomes, advance 
events, indications, and contraindications). How to determinate the right methods for the 
patients?  They need to summarize as a Table and updated the new reports as the report  of 
Frenkel (Hindawi Case Reports in Surgery Volume 2017, Article ID 6940649, 7 pages 
https://doi.or g/10.1155/2017/6940649  
 
In the past, the terms Brunner gland hyperplasia, Brunner gland hamartoma, and Brunner gland 
adenoma have been used interchangeably causing some confusion in the pathologic classification 
of these lesions.Brunner gland hyperplastic  polyps are usually small (0.5 cm -1.5 cm), 
asymptomatic, and discovered incidentally during upper endoscopy performed for other reasons. 
Brunner gland hamartomas are larger (.2 cm), and when symptomatic, present as gastrointestinal 
(GI) hemorrhage or intes tinal obstruction, often requiring endoscopic or surgical resection.The 
concept of Brunner gland adenoma is very contro - versial and still a matter of ongoing debate.In 
fact, prior reports of several large Brunner gland proliferative lesions without defini tive evidence 
of cytologic atypia that were reported as Brunner gland adenomas,5,7 in retrospect, represent 
examples of Brunner gland hyperplastic polyps or Brunner gland hamartomas. Brunner gland 
hyperplastic nodules/polyps and Brunner gland hamartomas ar e now believed to represent a 
morphologic continuum of benign hyperplastic/proliferative lesions of Brunner glands. As such, 
the term Brunner gland hyperplasia/hamartoma has been proposed for describing these 
nonneoplastic lesions.(Arch Pathol Lab Med. 201 9;143:370 -385; doi: 10.5858/ arpa.2018 -0034 -
RA) The authors need to check this with their pathologist.  
 
The authors believe that the endoscopic resection should been much safer if they  had performed 
a EUS(page 5 line 23 -25). Why ? The authors need to disc uss the importance of EUS.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in y our comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any w ay gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or sal ary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
I declare that I have no competing interests' below.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I ag ree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be inc luded in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  A Giant Brunner’s Gland Hamartoma being treated as a pedunculated polyp: a case report  
 
Version: 0 Date: 05 Jul 2019 
 
Reviewer:  Chih Wei  Tseng  
 
Reviewer’s report:  
 
This is an interesting case of a large Brunner's glang harmatoma  being treated as a pedunculated 
polyp with hard snare polypecto my. The authors concluded that the pedunculated large Brunner's 
glang harmatoma can be hard snare polypectomy with good safety.  
 
 
Major issues:  
 
Several reports disscues about the endoscopi c and surgical treatment for large Brunner's glang 
harmatoma. The recent work added few new information. They authors need to perform minimal 
review and disscue the difference between two methods ( including clinical outcomes, advance 
events, indications, and contraindications). How to determinate the right methods for the 
patients?  They need to summarize as a Table and updated the new reports as the report  of 
Frenkel (Hindawi Case Reports in Surgery Volume 2017, Article ID 6940649, 7 pages 
https://doi.or g/10.1155/2017/6940649  
 
In the past, the terms Brunner gland hyperplasia, Brunner gland hamartoma, and Brunner gland 
adenoma have been used interchangeably causing some confusion in the pathologic classification 
of these lesions.Brunner gland hyperplastic  polyps are usually small (0.5 cm -1.5 cm), 
asymptomatic, and discovered incidentally during upper endoscopy performed for other reasons. 
Brunner gland hamartomas are larger (.2 cm), and when symptomatic, present as gastrointestinal 
(GI) hemorrhage or intes tinal obstruction, often requiring endoscopic or surgical resection.The 
concept of Brunner gland adenoma is very contro - versial and still a matter of ongoing debate.In 
fact, prior reports of several large Brunner gland proliferative lesions without defini tive evidence 
of cytologic atypia that were reported as Brunner gland adenomas,5,7 in retrospect, represent 
examples of Brunner gland hyperplastic polyps or Brunner gland hamartomas. Brunner gland 
hyperplastic nodules/polyps and Brunner gland hamartomas ar e now believed to represent a 
morphologic continuum of benign hyperplastic/proliferative lesions of Brunner glands. As such, 
the term Brunner gland hyperplasia/hamartoma has been proposed for describing these 
nonneoplastic lesions.(Arch Pathol Lab Med. 201 9;143:370 -385; doi: 10.5858/ arpa.2018 -0034 -
RA) The authors need to check this with their pathologist.  
 
The authors believe that the endoscopic resection should been much safer if they  had performed 
a EUS(page 5 line 23 -25). Why ? The authors need to disc uss the importance of EUS.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in y our comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any w ay gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or sal ary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
I declare that I have no competing interests' below.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I ag ree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be inc luded in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant