GI Endoscopy · 1 min read
Endoscopic Resection of Giant Gastric Polyp to Treat Upper GI Bleeding
How Endoscopic Snare Resection Solved Both Bleeding and Malignancy Risk
Experienced teaching points
Clinical Pearls
- Endoscopic snare resection is a viable, definitive treatment for upper GI bleeding caused by large gastric polyps with stigmata of hemorrhage.
- When resecting a bleeding, large-pedicle polyp, always pre-inject the stalk with a saline-epinephrine mix (1:10,000) to minimize intraprocedural bleeding and improve the safety margin.
- To prevent delayed post-polypectomy bleeding, especially in the context of a prior hemorrhagic event, it is imperative to prophylacticly close the resection defect with hemostatic clips.
- Hyperplastic gastric polyps larger than 10 mm carry an increased risk of malignant transformation, making their removal a dual therapeutic and preventative measure.
Endoscopic Resection of Giant Gastric Polyp to Treat Upper GI Bleeding
Anand Dwivedi, MD
Gastroenterology Fellow, Carilion Memorial Hospital, Virginia Tech Carilion School of Medicine
Klaus Mönkemüller, MD, PhD, FASGE, FJGES
Professor of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
An elderly patient presented with massive hematemesis and drop in hemoglobin from 13 to 9 gr/dl. After hemodynamic stabilization an EGD was performed. A large antral polypoid lesion with stigmata of hemorrhage was seen (A, B).
The polyp had a large and thick pedicle (C). The pedicle was injected with saline-epinephrine mix (1:10,000) (D). Endoscopic resection was performed using a snare (E). The resection defect was closed using two clips (F, G). Panel H shows a 4 cm large pedunculated polyp. Histology showed a gastric hyperplastic polyp with no malignant features. The patient did not have any additional bleeding episodes.
This case shows that endoscopic resection may be an option to treat upper gastrointestinal bleeding. Two solutions were provided in one session a) removal of the source of bleeding (plus applying hemostatic clips to the resection site to prevent a post-polypectomy bleeding) and b) removal of a pre-malignant lesion. It is important to emphasize that hyperplastic gastric polyps larger than 10 mm carry an increased risk of transformation into cancer (1).
References:
1. Fry LC, Lazenby AJ, Lee DH, Mönkemüller K. Signet-ring-cell adenocarcinoma arising from a hyperplastic polyp in the stomach. Gastrointest Endosc. 2005 Mar;61(3):493-5. doi: 10.1016/s0016-5107(04)02640-9. PMID: 15758936.
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