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.
Raleigh Medical Group Gastroenterology, Raleigh, North Carolina, USA
Anand Dwivedi, MD, is a gastroenterologist with Raleigh Medical Group Gastroenterology in North Carolina. He earned his medical degree from the Brody School of Medicine at East Carolina University, completed internal medicine residency at Wake Forest University Baptist Medical Center where he served as Chief Resident, and completed his gastroenterology fellowship at Carilion Clinic / Virginia Tech in 2025. His clinical interests include general gastroenterology, inflammatory bowel disease, and esophageal motility disorders.
Professor of Medicine, Carilion Memorial Hospital / Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE, is the editor-in-chief of The Practicing Endoscopist and the founder of EndoCollab. He is Professor of Medicine at Virginia Tech Carilion School of Medicine and a practicing endoscopist at Carilion Memorial Hospital in Roanoke, Virginia.
Dr. Mönkemüller has published extensively on endoscopic techniques and devices, with a particular focus on therapeutic endoscopy, foreign body removal, GI bleeding, and the use of caps and accessories in everyday practice. He lectures internationally and has contributed to multiple GI endoscopy textbooks and atlases.
