Pyloric gland adenoma (PGA) is a rare gastrointestinal tumor that is characterized
by dense packing of gastric pyloric glands with occasional cystic dilatation [1]. PGAs represent almost 2.7% of all gastric polyps with a conversion rate of 47%
to invasive adenocarcinoma [2]. There are currently no evidence-based recommendations on resection technique and
surveillance protocol specific for PGAs. Previously reported large gastric PGA was
treated with laparoscopic resection [1]. However, endoscopic submucosal dissection (ESD) has been recently used in the treatment
of smaller PGAs [3]
[4]. Herein, we report a rare case of huge gastric PGA treated with ESD.
A 68-year-old female came to our hospital with complaints of recurrent abdominal pain
and vomiting. Laboratory investigations were unremarkable apart from iron deficiency
anemia. Gastroscopy revealed a huge polypoidal mass with a thick stalk arising from
the anterior gastric wall and occupying the fundus. Biopsy suggested PGA with low-grade
dysplasia. The colonoscopy was unremarkable. Subsequently, abdominal computed tomography
showed an intragastric polypoidal mass occupying the lumen with no extra-gastric extension
or lymph nodes. The lesion was removed by ESD using a 3-mm ball-type knife Endocut
Q, effect 2, for incision, forced coagulation 4 for dissection, and soft coagulation
5 using coagulation grasper for hemostasis, followed by resection bed closure with
5 endoclips (17 mm) with no intraprocedural complications ([Video 1]). The resected specimen was retrieved in piecemeal and measured about 13 cm × 9
cm ([Fig. 1]). Pathological examination of the lesion revealed tubular adenomatous proliferation
with packed and dilated pyloric glands with ground glass cytoplasm lined and covered
with mildly atypical cells with low mitotic activity consistent with PGA with low-grade
dysplasia and clear deep resection margin ([Fig. 2]). No adverse events were reported after the procedure. The patient was discharged
after 1 day and scheduled for follow-up gastroscopy after 3 months.
Endoscopic submucosal dissection of an uncommon huge gastric pyloric gland adenoma.Video
1
Fig. 1 Endoscopic submucosal dissection of gastric pyloric gland adenoma: a polypoidal mass with thick stalk occupying the fundus, b stalk incision with 3-mm ball-type knife, c dissection with forced coagulation, d resection bed closure with 5 endoclips, and e, f the resected specimen measured about 13 cm × 9 cm.
Fig. 2 Pathological examination of the retrieved specimen: a, b tubular adenomatous proliferation with packed and dilated pyloric glands, c lined and covered with mildly atypical cells, and d ground glass cytoplasm, consistent with PGA with low-grade dysplasia.
Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB
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