Endoscopic Management of Gastric Polyp with Outlet Obstruction without Polypectomy

Abstract

Although gastric polyp is usually an incidental endoscopic finding, large-sized polyps can cause symptoms ranging from epigastralgia to bleeding from ulcerated polyps and gastric outlet obstruction. Although the gold standard of treatment is removal of the polyp either through endoscopic polypectomy or surgical excision, complications associated with these procedures cannot be ignored. The risk becomes a major concern for patients at high risk for surgery when complications arise. We describe a debilitated 74-year-old woman who presented with early satiety, intermittent postprandial nausea and vomiting for three months. Upper endoscopy revealed a 2.5 cm pedunculated polyp over the gastric antrum causing intermittent obstruction. Considering her high risk for polypectomy, detachable snaring was performed without polypectomy in an outpatient setting. The patient was complication-free with complete relief of obstructive symptoms one week after the procedure. Subsequent follow-ups showed satisfactory healing without signs of mucosal disruption or recurrence. The results suggest that detachable snaring without polypectomy may be a therapeutic option for high-risk patients with benign symptomatic gastric polyps.

Keywords: Detachable snare; Endoscopy; Gastric polyp.

Fig. 1

a Endoscopic picture demonstrating a pedunculated polyp over the gastric antrum near the pyloric ring with an easily identifiable stalk (arrow). b Application of a detachable snare over the base of the stalk (arrow). Note the ischemic change of the polyp. c Endoscopic follow-up three weeks after the procedure showing a small sessile submucosal elevation with intact mucosa over the previous site of snaring (arrow). d Inconspicuous elevation over the previous polyp location on endoscopic examination six months after the procedure (arrow).