Antral hyperplastic polyp causing intermittent gastric outlet obstruction: case report

Abstract

Background: Hyperplastic polyps are the most common polypoid lesions of the stomach. Rarely, they cause gastric outlet obstruction by prolapsing through the pyloric channel, when they arise in the prepyloric antrum.

Case presentation: A 62-year-old woman presented with intermittent nausea and vomiting of 4 months duration. Upper gastrointestinal endoscopy revealed a 30 mm prepyloric sessile polyp causing intermittent gastric outlet obstruction. Following submucosal injection of diluted adrenaline solution, the polyp was removed with a snare. Multiple biopsies were taken from the greater curvature of the antrum and the corpus. Rapid urease test for Helicobacter pylori yielded a negative result. Histopathologic examination showed a hyperplastic polyp without any evidence of malignancy. Biopsies of the antrum and the corpus revealed gastritis with neither atrophic changes nor Helicobacter pylori infection. Follow-up endoscopy after a 12-week course of proton pomp inhibitor therapy showed a complete healing without any remnant tissue at the polypectomy site. The patient has been symptom-free during 8 months of follow-up.

Conclusions: Symptomatic gastric polyps should be removed preferentially when they are detected at the initial diagnostic endoscopy. Polypectomy not only provides tissue to determine the exact histopathologic type of the polyp, but also achieves radical treatment.

Figure 1

A) A prepyloric polyp causing obstruction at the pyloric channel. B)Injection of diluted adrenaline solution to the base of the polyp. C) Removal of the polyp with a snare.

Figure 2

Hyperplastic surface epithelium and cystically dilated glands with inflammatory infiltration and smooth muscle cells in lamina propria, X40, H+E.

Figure 3

A complete healing at the polypectomy site was observed on the follow-up endoscopy after a 12-week course of PPI therapy.