Endoscopy 2021; 53(06): 659-660
DOI: 10.1055/a-1244-9147
E-Videos

Endoscopic resection of multiple large gastric polyps

Abhilash Perisetti
1  Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Hemant Goyal
2  Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
,
Benjamin Tharian
1  Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Sumant Inamdar
1  Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Shashank Garg
1  Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
› Author Affiliations

A 50-year-old woman with a past medical history of diabetes, end-stage renal disease, and hypertension presented to the gastroenterology clinic with melena and severe iron deficiency anemia (IDA). She reported no use of antithrombotic agents or nonsteroidal anti-inflammatory agents.

She underwent Helicobacter pylori stool testing, which was negative, and upper endoscopy, which showed normal appearing esophagus and duodenum. Examination of the stomach showed multiple antral pedunculated and semi-pedunculated, dome-shaped, multilobar, hemorrhagic, polypoid lesions, 2 – 3 cm in size, which were highly suggestive of hyperplastic polyps ([Fig. 1]). Endoscopic ultrasound showed the lesion to be limited to the mucosa with all layers intact ([Fig. 2]). As these lesions were presumed to be the cause of the IDA, an endoscopic band ligation was performed in an attempt to debulk the disease ([Fig. 3]). The polyps were suctioned and bands were applied from the distal to proximal location ([Video 1]). Immediate strangulation of the polyps was followed by congestion and cyanotic changes.

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Fig. 1 Semi-pedunculated benign-appearing gastric antral hyperplastic polyps.
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Fig. 2 Endoscopic ultrasound showed the lesion to be mucosal, with all layers intact. (Green arrow, mucosal polyp; left red arrow, deep mucosa; right red arrow, submucosa.)
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Fig. 3 Inspection of the polyp with gastroscope (with banding kit).

Video 1 Video showing resection of multiple gastric polyps with endoscopic band ligation.


Quality:

Following serial banding, no post-procedural bleeding or perforation was noted. The patient was discharged and a repeat upper endoscopy 8 weeks later showed healed ulcers with clear bases and complete resection of the polyps ([Fig. 4]), with a resolution of the melena and IDA.

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Fig. 4 Complete resection of the gastric polyps.

Hyperplastic polyps are the most common type of polyps in the stomach. Although the majority of hyperplastic polyps are asymptomatic, bleeding, obstruction, and rarely malignant transformation are noted. Resection of these polyps can be performed with snare polypectomy; however, this carries a risk of bleeding of 7.2 % [1]. Endoscopic band ligation is an effective technique, with complete resection of polyps achieved in a single session and with minimal risk of extensive bleeding. Furthermore, the risk of perforation is low. It can be used for both sessile and pedunculated polyps [2].

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Publication History

Publication Date:
11 September 2020 (online)

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