Pontone Stefano, Pironi Daniele, Eberspacher Chiara, Pontone Paolo, Filippini Angelo
Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
Ann Ital Chir. 2011 Jul-Aug;82(4):297-300.
Gastric hyperplastic polyps are often asymptomatic and are found incidentally at upper endoscopy performed for unrelated reasons. Although they are considered a benign lesion, all symptomatic polyps should be removed for a more reliable histological diagnosis, resolution of symptoms and to prevent potential malignant transformation. In fact, there are no significant difference between pure gastric hyperplastic polyps and gastric hyperplastic polyps with neoplastic transformation in the number, location, or gross appearance of polyps. If symptomatic, patients usually complain of dyspepsia, heartburn, abdominal pain or upper gastrointestinal bleeding leading to anaemia. Complete or incomplete gastric outlet obstruction with intermittent symptoms, may rarely be caused by gastric hyperplastic polyps. We described the management of a rare case of intermittent gastric outlet obstruction caused by a large hyperplastic antral polyp prolapsing through the pylorus. Using hydroxypropylmethylcellulose, a new lifting agent, firstly from pyloric side, we obtained a reliable long-lasting submucosal cushion under the lesion which allowed a stable repositioning of the polyp in the gastric lumen without making additional infiltration during the endoscopic mucosal resection. Innovative lifting agents could significantly reduce the procedure time, but additional studies should be performed on this area to confirm preliminary results. Endoscopic mucosal resection not only provides tissue to determine the exact histopathologic type of the polyp, but also achieves symptomatic treatment.
胃增生性息肉通常无症状，多在因其他无关原因进行上消化道内镜检查时偶然发现。尽管它们被认为是良性病变，但所有有症状的息肉都应切除，以便获得更可靠的组织学诊断、缓解症状并预防潜在的恶性转化。事实上，单纯胃增生性息肉与发生肿瘤转化的胃增生性息肉在息肉的数量、位置或大体外观上并无显著差异。有症状的患者通常主诉消化不良、烧心、腹痛或上消化道出血导致贫血。胃增生性息肉很少会引起间歇性症状的完全或不完全胃出口梗阻。我们描述了一例罕见的由巨大增生性胃窦息肉经幽门脱垂引起的间歇性胃出口梗阻的处理过程。我们首先从幽门侧使用一种新型的抬举剂羟丙基甲基纤维素，在病变下方获得了一个可靠且持久的黏膜下垫，这使得息肉能够稳定地重新定位到胃腔内，并且在内镜黏膜切除术中无需进行额外的浸润操作。创新的抬举剂可以显著缩短手术时间，但在此领域还应进行更多研究以证实初步结果。内镜黏膜切除术不仅能提供组织以确定息肉的确切组织病理学类型，还能实现对症治疗。
