Masuda Naoya, Yamazaki Kenji, Maruyama Yasuhiko, Kushima Ryoji, Hasebe Nae, Ozawa Noritaka, Shimizu Shogo, Shimizu Masahito
Department of Gastroenterology Gifu Prefectural General Medical Center Gifu Japan.
Department of Gastroenterology Gifu University School of Medicine Gifu Japan.
DEN Open. 2025 Mar 11;5(1):e70094. doi: 10.1002/deo2.70094. eCollection 2025 Apr.
Endoscopic submucosal dissection (ESD), the standard treatment for early gastric cancer, typically results in homogeneous flat scars. However, in some cases, polypoid nodule scars (PNS) may develop, complicating the cancer recurrence assessment. This case report describes a 60-year-old man with a history of infection who underwent two ESD procedures: first for early antral gastric cancer and then for gastric body adenoma. Subsequently, an erythematous protruding lesion developed at the antral ESD scar site. Lesion biopsy revealed regenerative and hyperplastic tissue growth, consistent with PNS. Despite eradication therapy and discontinuation of potassium-competitive acid blockers and H-receptor antagonists, the lesion continued to enlarge. PNS growth may be caused by excessive mucosal regeneration and enhanced antral peristalsis, suggesting that hypergastrinemia, which may enhance these effects, may be an underlying cause. Further, elevated serum gastrin levels, decreased pepsinogen levels, the presence of antiparietal cell antibodies, and consistent pathological findings confirmed autoimmune gastritis (AIG). This case highlights the diagnostic challenges of AIG, especially in cases of active or previous infection because typical endoscopic features may be obscured. Persistent PNS after ESD warrants the consideration of excessive mucosal regeneration and enhanced peristalsis, with AIG as a potential cause because of its association with hypergastrinemia. To our knowledge, this is the first case report describing a potential link between AIG and PNS.
内镜黏膜下剥离术（ESD）是早期胃癌的标准治疗方法，通常会导致均匀的扁平瘢痕。然而，在某些情况下，可能会出现息肉样结节瘢痕（PNS），使癌症复发评估变得复杂。本病例报告描述了一名60岁有感染史的男性，他接受了两次ESD手术：第一次用于治疗早期胃窦癌，第二次用于治疗胃体腺瘤。随后，胃窦ESD瘢痕部位出现了一个红斑性突出病变。病变活检显示为再生性和增生性组织生长，符合PNS。尽管进行了根除治疗，并停用了钾竞争性酸阻滞剂和H受体拮抗剂，但病变仍继续增大。PNS生长可能是由于黏膜过度再生和胃窦蠕动增强所致，这表明可能增强这些作用的高胃泌素血症可能是一个潜在原因。此外，血清胃泌素水平升高、胃蛋白酶原水平降低、抗壁细胞抗体的存在以及一致的病理结果证实为自身免疫性胃炎（AIG）。本病例突出了AIG的诊断挑战，尤其是在有活动性或既往感染的病例中，因为典型的内镜特征可能会被掩盖。ESD后持续存在的PNS值得考虑黏膜过度再生和蠕动增强，AIG因其与高胃泌素血症的关联而可能是一个潜在原因。据我们所知，这是第一例描述AIG与PNS之间潜在联系的病例报告。
