Alimentary tract and pancreas

Alimentarni trakt i pankreas

1Saša Grgov,

1Perica Stamenkovi},

2Miroslav Stefanovi}

1Gastroenterology Unit,

2Department of Pathology,

Health Center of Leskovac, Serbia.

ARCH GASTROENTEROHEPATOL 2003; 22 (No 1 - 2): 12 – 17

Images in clinical gastroenterology

Endoloop-assisted resection

of large gastric polyp

Resekcija velikog gastricnog polipa uz pomo}

"endoloop-a"

( accepted April 24th 2003 )

Sixty-year old patient was admitted for further evaluation

of his functional dyspepsia which manifested with

chronic epigastric pain, nausea, and occasional vomiting.

His was otherwise well noursihed gentleman enjoying

good health. His clinical findings was normal. All laboratory

investigations including: ESR, hematologic examination,

urinalysis, BUN, serum creatinine, blood sugar,

AST,ALT,GGT, alkaline phosphatase, total serum proteins,

serum albumin, PT,PTT time were all normal or negative.

Upper gastrointestinal (GI) endoscopy revealed near

pyloric ring,on the posterior wall of gastric antrum pedunculated

polyp 20 mm in diameter. His pedicle was 30mm

in lenght and 10mm in diameter.

Endoloop aplicator with placed throught the working

channel of the scope and Olympus endoloop (40mm in

diameter) was fixed on the pedicle of the polyp which

became livid in coulor. Figure 1. Further on electroresection

of the polyp was performed with polyp retriveal by

means of endobasket. Endoloop was left in situ around the

remnant of polyp pedicle without residual bleeding Figure

2,3. The patients was discharged next day. Twelve days

later follow-up upper GI endoscopy demonstrated completely

normal findings. There were no residual postpolypectmy

changes including the endolooped pedicle

remnant.

Histology of the polyp was: the resceted polyp was

brought to the pathologist in toto. This was gastric hyperplastic

polyp with normal basis and clear-cut resection

margin towards the gastric wall.

Comment: This is further to demonstrate the usefulness

of two step approach to the resection of large GI polyps

which may possibly bleed after polypectomy. Pre-resectional

endoloop placement around the polyp pedicle may

prevent postpolypectomy bleeding and obviate endoscopic

hemosatic procedures or open surery. It seems that in

selected cases this endoscopic approach to the large GI

polyps is simple,safe, and cost-effective. This imply the

necessity for further improvements in GI endoscopic programmes

for trainees.