Jun 9, 2013 - CONTROL ID: 1744270. ABSTRACT FINAL ID: None. TITLE: Large Hyperplastic Gastric polyp - a rare cause of Obscure gastrointestinal ...
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CONTROL ID: 1744270 ABSTRACT FINAL ID: None TITLE: Large Hyperplastic Gastric polyp - a rare cause of Obscure gastrointestinal bleeding AUTHORS/INSTITUTIONS: V. Garlapati, K.S. Zahid, H. Hertan, Gastroenterology & Hepatology, Montefiore Medical Center-Wakefield division, Bronx, New York, UNITED STATES; ABSTRACT BODY: Purpose: INTRODUCTION Gastric polyps are usually an incidental finding on upper endoscopy and are rarely a cause of obscure gastrointestinal bleeding. Hyperplastic polyps are the second most common type of gastric polyps after fundic gland polyps in United States. The incidence of hyperplastic polyps is decreasing due to the use of PPI’s and low prevalence of Helicobacter pylori infection. CASE REPORT A 83 year old female with comorbidities of Hypertension presented for evaluation of anemia (Hb=5.9) without overt bleeding and hemodynamic instability. Patient denied any history of melena, hematochezia, abdominal pain, post-menopausal spotting, but admitted to constipation, unintentional weight loss of 10 lbs and dyspnea on walking 1-2 blocks. No history of NSAID use. Fecal occult blood was negative and iron studies revealed iron deficiency anemia with transferrin saturation 9%. Patient received 2 units of PRBCs and underwent upper endoscopy which revealed a large 5 cm. pedunculated polyp in the body of stomach and multiple small 1-2 cm sessile polyps in body of stomach. Snare polypectomy of the large gastric polyp was performed. Histopathology of the polyp came back as hyperplastic polyp. Subsequent colonoscopy was negative. Repeat upper endoscopy revealed 10 sessile and pedunculated polyps in body of stomach. They were 0.5 to 2 cm. in size. Snare polypectomy of three large polyps was performed. Histopathology came back as hyperplastic polyps. Biopsies of the gastric body and antrum were obtained, which showed evidence of H.pylori positive chronic active gastritis. CONCLUSION Gastric polyps are usually asymptomatic. They rarely can present with gastrointestinal bleeding. Large polyps could also present with gastric outlet obstruction. Hyperplastic polyps are most common in H.pylori prevalent areas. Average size is 1 cm. Risk of malignant potential is reported as 0.5-7%, with highest risk in polyps greater than 2cm. in size. All patients with hyperplastic polyps should be tested for H pylori and treated, if detected. Hyperplastic polyps regress in size after treatment with a PPI. Any gastric polyp more than 2 cm. in size needs to resected. Follow-up endoscopy is recommended for surveillance of residual adenomatous polyps and new polyps. Our patient is a rare case of large gastric hyperplastic polyp presenting with obscure gastrointestinal bleeding and iron deficiency anemia. Methods: N/A Results: N/A Conclusion: N/A (No Table Selected) (No Image Selected)
