HCA Healthcare/USF Morsani College of Medicine GME/Largo Medical Center Largo, FL, United States
Muhammad Khan, MD, MPH1, Meir Mizrahi, MD2 1HCA Healthcare/USF Morsani College of Medicine GME/Largo Medical Center, Largo, FL; 2Florida Digestive Health Specialists, Largo, FL
Introduction: Treatment options are limited for recalcitrant gastric hyperplastic polyps which recur despite resection, especially in the setting of portal hypertension1,2.
Case Description/Methods: A 69 year old male with a history of Hepatitis C and cirrhotic liver disease presents for recurrent large (5-25 mm) gastric antral polyps developing despite endoscopic mucosal resection (EMR) every 2 months. He experiences moderate abdominal pain and nausea symptoms which are relieved after EMR of the antral lesions. Histopathology shows hyperplastic polyps with erosion and acute inflammation, negative for adenomatous change or H. pylori organism. Newer cryotherapy ablation using a through-the-scope balloon device was offered in lieu of usual EMR after a 2 month polyp recurrence. Repeat endoscopy 2 months after cryotherapy showed only mild polyp progression with decrease in patient report of pain or nausea (image 1).
Discussion: Treatment options for recalcitrant portal hypertensive gastric polyps are limited beyond EMR. Here we present a potential and safe therapeutic option with cryotherapy balloon ablation of lesions in the antrum. While initial treatment appears promising, progression over time and with multiple patients will need to be investigated.
1 Lam MC, Tha S, Owen D, Haque M, Chatur N, Gray JR, Yoshida EM. Gastric polyps in patients with portal hypertension. Eur J Gastroenterol Hepatol. 2011 Nov;23(12):1245-9.
2 Boyd JT, Lee L. Portal hypertension-associated gastric polyps. BMJ Case Rep. 2014 Jan 8;2014:bcr2013202312.
Figure: A) Lesion development prior to EMR. Lesion after B) initial cryotherapy, C) follow-up endoscopy, and D) follow-up cryotherapy.
Disclosures: Muhammad Khan indicated no relevant financial relationships. Meir Mizrahi indicated no relevant financial relationships.
Muhammad Khan, MD, MPH1, Meir Mizrahi, MD2. P2770 - “Freeze! Don’t Move!” - Halting Stubborn Polyp Progression, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
