Introduction: We present this case, because gastric polyps are rare and are often incidentally found on an esophagogastroduodenoscopy (EGD), with an incidence up to 5%, and are typically asymptomatic. This case emphasizes the unique finding of a gastric polyp causing intermittent gastric outlet obstruction and the importance of appropriate clinical work-up, despite the patient’s symptoms mimicking gastroparesis.
Case Description/Methods: A 36-year-old man, with a history of type 2 diabetes, presented with a one-year history of intermittent post-prandial bloating, nausea, early satiety, and emesis within one hour after a meal. He denied hematemesis, hematochezia, melena, dysphagia or odynophagia. He had no family history of gastrointestinal cancer. The patient had been placed on metoclopramide by his primary care provider prior to this presentation without resolution of symptoms.
His laboratory data was significant for hemoglobin of 11 g/dL, mean corpuscular volume 77.6, platelet count 283 x109/L, and serum ferritin 14 mcg/L (24-336 mcg/L).
An EGD revealed a single 20 mm pedunculated polyp with oozing blood at the gastric antrum. Intermittent prolapse of the polyp into the duodenal bulb was noted with peristalsis. For resection, the stalk of the polyp was injected with epinephrine (figure 1a) and was removed with a hot snare (figure 1b). Endoclips were placed to prevent bleeding. The remainder of the exam was unremarkable. Histopathological analysis demonstrated a hyperplastic polyp with mucosal erosion, and no dysplasia (figure 1c). The pathology was also negative for H.pylori. Patient’s symptoms had completely resolved at follow up.
Discussion: Gastric polyps are often incidentally found on an EGD, with rare cases of them causing symptoms. This case emphasizes the rare finding of a large antral hyperplastic polyp causing intermittent gastric outlet obstruction due to a “ball-valve” effect. The erosion of surface epithelium of the polyp was likely causing bleeding and resultant anemia. Hyperplastic polyps have malignant potential and should be resected completely.
Although the patient is at risk of gastroparesis due to his history of diabetes, this case highlights the importance of appropriate work-up including endoscopy for symptoms and laboratory data consistent with alarming features. Anchoring bias and premature closure can lead to delayed diagnosis and potential harm to the patient.
