Endoscopy 2021; 53(10): E376-E377
DOI: 10.1055/a-1300-0865
E-Videos

Successful endoscopic submucosal dissection of a large juvenile polyp in the stomach of an infant

Zhiyin Huang
1  Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
,
Hui Gong
1  Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
,
Linjie Guo
1  Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
,
Yongmei Xie
2  Department of Gastroenterology, West China Women’s and Children’s Hospital, Sichuan University, Chengdu, China
,
Bing Wei
3  Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
,
Chengwei Tang
1  Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
,
Bing Hu
1  Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
› Author Affiliations
 

A 5-month-old male infant suffered from massive upper gastrointestinal bleeding that resulted in a hemoglobin level of 48 g/L when he was referred to our hospital. A 4.2-cm mass of mixed density was detected in the stomach by enhanced abdominal computed tomography ([Fig. 1]). No family history of polyposis was recorded and there were no dark spots on the lips, hands, or feet.

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Fig. 1 Enhanced abdominal computed tomography showing a 4.2-cm mass of mixed density in the stomach of a 5-month-old male infant.

Gastroscopy showed a rounded and smooth-contoured polyp-like mass in the posterior wall of the upper stomach ([Fig. 2]). Endoscopic submucosal dissection (ESD) was indicated because of the presence of the large polyp ([Video 1]). Abundant angiogenesis of the mass led to bleeding during the ESD procedure. Coagrasper hemostatic forceps were used for hemostasis. After the polyp had been resected from the stomach ([Fig. 3]), the mass was cut into small pieces with a hook knife and the pieces were taken out individually with a snare ([Fig. 4]), because the mass was too large to pass through the cardia whole. Finally, the incision was closed with clips. Histopathological examination of the mass revealed characteristics of hamartomatous polyps that presented as a marked increase in the stromal cell compartment with predominant smooth muscle, distorted and dilated crypts, and inflammatory changes in the lamina propria, indicating a solitary juvenile polyp ([Fig. 5]). Follow-up gastroscopy performed a month later showed proper wound healing and no residual mass.

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Fig. 2 Gastroscopy revealing a polyp-like mass in the posterior wall of the upper stomach.

Video 1 Endoscopic submucosal dissection in a 5-month-old infant.


Quality:
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Fig. 3 Clear surface of the wound after dissection of the mass from the stomach.
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Fig. 4 The resected polyp (as reassembled), measuring 4.2 × 3.0 cm.
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Fig. 5 Histopathological characteristics of the solitary juvenile polyp, which presented a marked increase in the stromal cell compartment with predominant smooth muscle, distorted and dilated crypts, and inflammatory changes in the lamina propria (H&E staining).

Solitary juvenile polyps (size range: 3 mm to 2 cm) are common in the colorectum but rarely reported in the stomach, especially in infancy [1]. The patient reported here may be the first and the youngest to present with a large gastric juvenile polyp (4.2 cm). Successful ESD not only resected the large polyp but also preserved the integrity of this infant’s stomach [2]. To the best of our knowledge, he is the youngest patient so far to have undergone ESD.

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB

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Competing interests

The authors declare that they have no conflict of interest.

Acknowledgements

The authors acknowledge receiving funding from the Chengdu Science and Technology Bureau (China) (2017-CY02-00023-GX).


Corresponding author

Bing Hu, MD
Department of Gastroenterology
Sichuan University West China Hospital
No. 37, Guo Xue Xiang Chengdu
Sichuan 610041
P. R. China   
Fax: +86-28-85422387   

Publication History

Publication Date:
03 December 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Enhanced abdominal computed tomography showing a 4.2-cm mass of mixed density in the stomach of a 5-month-old male infant.
Zoom Image
Fig. 2 Gastroscopy revealing a polyp-like mass in the posterior wall of the upper stomach.
Zoom Image
Fig. 3 Clear surface of the wound after dissection of the mass from the stomach.
Zoom Image
Fig. 4 The resected polyp (as reassembled), measuring 4.2 × 3.0 cm.
Zoom Image
Fig. 5 Histopathological characteristics of the solitary juvenile polyp, which presented a marked increase in the stromal cell compartment with predominant smooth muscle, distorted and dilated crypts, and inflammatory changes in the lamina propria (H&E staining).