A 45-year-old woman was admitted to our department having suffered from intermittent
abdominal pain in the preceding months. Endoscopy of the upper gastrointestinal tract
revealed a bizarrely shaped polyp, 10 cm in size and with a broad base located in
the gastric body ([Fig. 1]), which at times protruded through the pylorus ([Fig. 2]). Such a giant gastric polyp is a rare finding [1]
[2]
[3]
[4]. The surface of the polyp, positioned within the pyloric channel, was ulcerated.
The polyp was easily retracted into the gastric cavity. Endosonographic examination
revealed no major feeding vessels within the polyp. No infiltration into deeper layers
of the gastric wall was observed. Histological study of biopsies taken gave no evidence
of malignancy.
Fig. 1 Gastric polyp inserting in the corpus, large free part about 10 cm in length. Ulcerated
area covered with fibrin, about 1.5 cm in diameter.
Fig. 2 Polyp protruding through the pylorus. This probably caused the patient’s pain by gastric
outlet obstruction and anemia due to ulceration of mechanically stressed surfaces.
The option of surgical resection was discussed with the patient, but she preferred
an endoscopic approach. An overtube was placed in the upper esophagus to protect against
aspiration. To reduce bleeding, a total of 30 ml epinephrine solution (diluted 1 : 10 000)
was injected into the base of the polyp. A snare was positioned close to the base
and electrical current applied for a total of 45 min, but the polyp was not completely
transected. The endoscope was therefore removed (leaving the snare in place) and a
second snare was placed to resect the upper 5 cm of the polyp ([Fig. 3]). The first snare was then repositioned, the remaining part of the polyp was removed
in a three-step-procedure and its fragments were collected with a Dormia basket. Discreet
bleeding from the center of the polyp base was well controlled by epinephrine injection.
Control examination revealed a small remnant which was removed 3 months later as histology
documented a hyperplastic polyp with an increased proliferation rate. The last follow-up
examination, 18 months after resection, showed an excellent result as only a white
scar was evident at the point of resection ([Fig. 4]).
Fig. 3 Polyp base subsequent to resection and injection of epinephrine solution to control
minor bleeding.
Fig. 4 Follow-up examination 18 months after endoscopic resection. White scar corresponds
to former polyp base.
Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB
