Giant Hyperplastic Polyp at the Gastroesophageal Junction: A Rare Provocateur of Upper Gastrointestinal Bleeding

Abstract

Esophageal hyperplastic polyps (HPs) are a rare benign polypoidal growth most commonly resulting from gastroesophageal reflux disease (GERD). The lesion is asymptomatic in most patients unless large enough to cause luminal obstruction or gastrointestinal bleeding. The treatment of choice is endoscopic resection if it becomes symptomatic. Here, we report a case of a 51-year-old woman presenting with dyspeptic symptoms and upper gastrointestinal bleeding. An upper gastrointestinal endoscopy showed a large polyp with active oozing of blood at the gastroesophageal junction (GEJ), which was removed endoscopically after injecting adrenaline at its base. Histopathological analysis was suggestive of HPs.

Keywords: endoscopic resection; histological features; hyperplastic polyp of the gastroesophageal junction; medical management; upper gastrointestinal bleeding.

Figure 1. Endoscopic images showing (A) a polypoidal lesion arising from the GEJ, (B) a large pedunculated polyp hanging down in the stomach from the distal esophagus (GEJ) on retroflection, and (C) hot snare polypectomy.

Figure 2. (A) (Hematoxylin and eosin (H&E) 4X magnification) Hyperplastic polyp with surface ulceration and granulation tissue formation (black arrow). (B & C) (H&E 4X magnification) Hyperplastic polyp with variably dilated mucus-secreting glands and intervening fibrotic and mildly inflamed stroma (blue arrows). (D) (H&E 20X magnification) High-power view of mucous-secreting glands.

There is no adenomatous change (red arrow).

Figure 3. Upper gastrointestinal endoscopy after two years showing a small polyp (arrow) at the same site of the previously removed polyp.