Gastric Polyp
Giant Multilobulated Gastric Polyp

Video Endoscopic Sequence 1 of 20.

Giant Multilobulated Gastric Polyp

This 65 year-old woman, presented this asymptomatic large mass discovered as an incidental finding at an endoscopic examination.

Gastric polyps are usually found incidentally on upper gastrointestinal endoscopy performed for an unrelated indication and only in rare cases do they cause symptoms. Nevertheless, the diagnosis and appropriate management of gastric polyps are important, as some polyps have malignant potential.

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Giant Multilobulated Gastric Polyp

Video Endoscopic Sequence 2 of 20.

Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

In 1968, the first report of a successful endoscopic gastric polypectomy was published and, as of this moment, the therapeutic approach to these injuries changed radically.

 

 

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

Video Endoscopic Sequence 3 of 20.

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

This picture shows a large multilobulated polyp located in the proximal gastric body.

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

Video Endoscopic Sequence 4 of 20.

Zoom Endoscopy.

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

 

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

Video Endoscopic Sequence 5 of 20.

A polypectomy begin to be performed

A dilution of adrenaline with 1/20.000 in dextrosa 50% was injected in the base of the wide pedicle.

 

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

Video Endoscopic Sequence 6 of 20.

Application of hemoclips.

Resection of a pedunculated polyp with prophylactic hemoclips. A: pedunculated polyp and thick pedicle. hemoclips have been used prophylactically for thick-pedicle polyps prior to resection with an endoscopic snare.

 

Endoscopic clip ligation of polyp stalk to prevent bleeding after snare polypectomy.

Video Endoscopic Sequence 7 of 20.

Endoscopic clip ligation of polyp stalk to prevent bleeding after snare polypectomy.

 

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

Video Endoscopic Sequence 8 of 20.

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

Again A dilution of adrenaline with 1/20.000 in dextrosa 50 % is injected in the base of the wide pedicle.

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

Video Endoscopic Sequence 9 of 20.

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

Metallic hemoclips have been endoscopically placed in the gastrointestinal tract for the treatment of bleeding lesions and closure of perforation. A further potential application is the ligation of the pedunculated polyps prior to polypectomy as a prophylactic measure to prevent bleeding.

 

Endoscopy of Giant Multilobulated Gastric Polyp with Large and Wide Stalk.

Video Endoscopic Sequence 10 of 20.


Being removed with a snare around its large stalk. A rapid cut current was applied to prevent burning at the clip site.

In the video clip, note the traction used to avoid transmural injuries.


 

The large mass has been removed endoscopicaly.

Video Endoscopic Sequence 11 of 20.

The large mass has been removed endoscopicaly.

 

Gastric Polyp

Video Endoscopic Sequence 12 of 20.

With the help with this basket, the resected mass is being retrieved.

 

Gastric Polyp

Video Endoscopic Sequence 13 of 20.

Gastric Polyp

Video Endoscopic Sequence 14 of 20.

Gastric Polyp

Video Endoscopic Sequence 15 of 20.

Status post polypectomy,

 

Gastric Polyp

Video Endoscopic Sequence 16 of 20.

Macroscopic image of the specimen.

 

Gastric Polyp

Video Endoscopic Sequence 17 of 20.

 

Gastric Polyp

Video Endoscopic Sequence 18 of 20.

 

Gastric Polyp

Video Endoscopic Sequence 19 of 20.

 

Gastric Polyp

Video Endoscopic Sequence 20 of 20.

 

Giant Gastric Hyperplastic Polyp

Video Endoscopic Sequence 1 of 15.

Giant Gastric Hyperplastic Polyp

This is a 43 year-old, female who was admitted to emergency for having hematemesis, endoscopy was performed finding this ulcerated mass.

 

 

 

 

Giant Gastric Polyp

Video Endoscopic Sequence 2 of 15.

The fairly wide pedicle is observed

In view of the potential cancer risk, all hyperplastic polyps larger than 1 cm should be excised completely. If dysplasia or intramucosal carcinoma is found, but the stalk is not affected, the lesion can be considered completely removed and most likely cured. The excision of the polypoid lesion always should be accompanied by additional sampling of the unaffected mucosa to obtain reliable information about the topography and severity of the background gastritis and atrophy.

 

Giant Gastric Polyp

Video Endoscopic Sequence 3 of 15.

The pedicle comes from the pre-pyloric antrum

When hyperplastic polyps arise in a background of chronic atrophic gastritis (a precursor lesion for gastric adenocarcinoma) the severity and extent of the atrophic gastritis should be evaluated. Risk stratification for gastric cancer can be assessed histologically using the Operative Link for Gastritis Assessment (OLGA) or the Operative Link on Gastritis/Intestinal Metaplasia Assessment staging systems. Both require histologic grading of adequate samples from the antrum and corpus; grades then are combined to provide a risk stratification category. One can use the 5-biopsy specimen protocol recommended by the updated Sydney system.

Giant Gastric Polyp

Video Endoscopic Sequence 4 of 15.

Another image and video of the giant polyp

Giant Gastric Polyp

Video Endoscopic Sequence 5 of 15.

initiate the endoscopic polypectomy with loop diathermy, no infiltration is not used in the pedicle.

 

Endoscopic Polypectomy

Video Endoscopic Sequence 6 of 15.

In the Image as well as the video clip show the endoscopic polypectomy of this mass, and the effect of cutting the pedicle with the loop diathermy using cautery of 40 watts.

 

Giant Gastric Polyp

Video Endoscopic Sequence 7 of 15.

The mass it observed that already cut

Giant Gastric Polyp

Video Endoscopic Sequence 8 of 15.

It proceeds to remove

Giant Gastric Polyp

Video Endoscopic Sequence 9 of 15.

It is observed broad-based pedicle

Giant Gastric Polyp

Video Endoscopic Sequence 10 of 15.

It applies to the pedicle, ablative therapy with argon plasma coagulator

Giant Gastric Polyp

Video Endoscopic Sequence 11 of 15.

Final status of endoscopic polypectomy

 

Giant Gastric Polyp

Video Endoscopic Sequence 12 of 15.

Giant Gastric Hyperplastic Polyp, removed by endoscopic polypectomy.

To enlarge and open the image in a new window pressing on it

 

Giant Gastric Polyp

Video Endoscopic Sequence 13 of 15.

Giant Gastric Hyperplastic Polyp, removed by endoscopic polypectomy.

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Giant Gastric Polyp

Video Endoscopic Sequence 14 of 15.

Giant gastric polyp removed by endoscopic polypectomy

To enlarge and open the image in a new window pressing on it

Giant Gastric Polyp

Video Endoscopic Sequence 15 of 15.

Another image of the tumor

To enlarge and open the image in a new window pressing on it

Gastric Polyp

Video Endoscopic Sequence 1 of 14.

This is the case of a 62 year-old male with two hyperplasic polyps and one tiny ulcerated lesion at the pre-pyloric antrum of the lesser curvature. One of the polyps was located in the gastroesofagic junction, and the other in the antrum. By biopsies hyperplasic nature was confirmed.

We decided to use the strangulate method with rubber bands instead of the traditional endoscopic polypectomy.

 

Gastric Polyp

Video Endoscopic Sequence 2 of 14.

Contrast Indigo Carmine Chromoscopy.

 

Gastric Polyp

Video Endoscopic Sequence 3 of 14.

In this image as well as the video clip is observed the polyp of the gastroesophageal junction.

 

Gastric Polyp

Video Endoscopic Sequence 4 of 14.

The polyp at the antrum.

 

gastric polyp

Video Endoscopic Sequence 5 of 14.

The therapeutic treatment with the rubber bands is initiated.

Endoscopic ligation is highly effective in obliterating polyps. The use of a multibander device for endoscopic polypectomy is technically feasible and safe, and its use results in more rapid ablation of gastric polyps.

 

gastric polyp

Video Endoscopic Sequence 6 of 14.

Two rubber bands have been placed at the stalk.

Endoscopic band ligation for bleeding small-bowel vascular lesions has been reported as safe and efficacious based on small case series. There have been several other published case reports of band ligators used for bleeding lesions, usually Dieulafoy's lesions, in the stomach, the proximal small bowel, and the colon. In addition, this method has been used for postpolypectomy bleeding stalks.

gastric polyp

Video Endoscopic Sequence 7 of 14.

Other two bands were placed to the polyp of the gastroesophageal junction.

gastric polyp

Video Endoscopic Sequence 8 of 14.

Strangulating the mucosa of the ulcerated lesion of
the antrum.

 

gastric polyp

Video Endoscopic Sequence 9 of 14.

In the image and the video are observed two polyps that have been ligated.

Historically, in the pre-endoscopic era, the patients with polyps of upper digestive tract were treated with surgical resection; the patients with low risk did not operate unless a change in size of the polyp noticed or malignant degeneration in the radiological studies were suspected.

 

gastric polyp

Video Endoscopic Sequence 10 of 14.

The polyp of the cardia with two bands.

 

gastric polyp

Video Endoscopic Sequence 11 of 14.

Another image and video of the strangled polyps.

 

gastric polyp

Video Endoscopic Sequence 12 of 14.

On the following day, approximately 30 hours later, a new endoscopy was performed, observing the effectiveness of this method.

Rest of medicines are observed adhered.

 

 

gastric polyp

Video Endoscopic Sequence 13 of 14.

The necrosis caused by the bands is demonstrated.

gastric polyp

Video Endoscopic Sequence 14 of 14.

In the case of the polyp of the cardia the polyp in almost its
totality has been only given off, observing only the two
bands in stalk.

 

Hyperplastic Polyp

Video Endoscopic Sequence 1 of 8.

Hyperplastic Polyp.

This 30 year-old female, presented with a large mass. One year previously, this lesion was small, we wanted to snare it but patient did not show up, at that time the biopsies reveled a hyperplastic polyp. Argon Plasma Coagulator was used as a therapeutical approach.

 

Hyperplastic Polyp

Video Endoscopic Sequence 2 of 8.

Chromoendoscopy with indigo carmin.

 

Gastric polyp

Video Endoscopic Sequence 3 of 8.

The image and the video clip display the extension of the large mass.

 

Gastric polyp

Video Endoscopic Sequence 4 of 8.

Three months after a follow up endoscopy was performed.

Status post coagulation with argon plasma coagulator is observed. This mass has been diminished in size.

 

Gastric polyp

Video Endoscopic Sequence 5 of 8.

Another image and video clip.

 

Gastric Polyp

Video Endoscopic Sequence 6 of 8.

A new treatment with argon plasma coagulator is being performed.

 

Video Endoscopic Sequence 7 of 8.

This image and the video clip show the coagulation with argon plasma coagulator.

 

Gastric polyp

Video Endoscopic Sequence 8 of 8.

Appearance post APC.

 

Hyperplastic Gastric Polyposis

Video Endoscopic Sequence 1 of 6.

Hyperplastic Gastric Polyposis.

 


 

Hyperplastic Gastric Polyposis

Video Endoscopic Sequence 2 of 6.

Many hyperplastic polyps are found incidentally on gastroscopy. Physical findings are not specific. Hyperplastic polyps are by far the most common histologic type, and they can vary in location, number, and size. Most are less than 2 cm. Although these polyps harbor no malignancy, they may be accompanied by atrophic gastritis, which predisposes the nonpolypoid mucosa to malignant transformation.

If present, H pylori should be eradicated and an endoscopic follow-up evaluation should be scheduled between 3 and 6 months after therapy to confirm successful eradication. Alternatively, a noninvasive test such as the urea breath test may be used. In many instances any remaining small hyperplastic polyps will have regressed or disappeared.

 

Hyperplastic Gastric Polyposis

Video Endoscopic Sequence 3 of 6.

Hyperplastic polyps are the most frequently encountered subtype of gastric polypoid lesions. They are usually associated with chronic gastritis or H pylori gastritis.They may harbour adenomatous changes or dysplastic foci. Therefore, endoscopic polypectomy seems as a safe and fast procedure for both diagnosis and treatment of gastric polypoid lesions at the same session. In addition, edematous mucosa may appear misleadingly as a polypoid lesion in some instances and it can be ruled out only by histopathologic examination.

 

Hyperplastic Gastric Polyposis

Video Endoscopic Sequence 4 of 6.

Numerous fundic gland polyps in the gastric corpus.

Because most polyps are found incidentally during upper endoscopies, it is crucial that the endoscopist be prepared to acquire as much information as possible during the procedure to help with the future management of the polyp.

If the appearance strongly suggests fundic gland polyps, biopsy specimens from 1 or more polyps should be taken; polyps larger than 1 cm should be resected. In the setting of fundic gland polyps special attention should be given to atypical-looking lesions, all of which should undergo a biopsy examination because they may represent other, more clinically relevant, lesions. If the appearance is not suggestive of fundic gland polyps, the endoscopist should consider complete removal of all polyps that measure 1 cm or more; if not removed such polyps should be adequately sampled. In the case of larger polyps, after the histopathologic diagnosis is received, a decision needs to be made regarding whether polypectomy is needed and, if it is, should it be endoscopic or surgical. Several factors should be considered when making that decision: risk of missing more serious pathology in the large polyps.


 

Hyperplastic Gastric Polyposis

Video Endoscopic Sequence 5 of 6.

Chromoendoscopy with indigo carmin.

 

Hyperplastic Gastric Polyposis

Video Endoscopic Sequence 6 of 6.

More images and video clips of this case of multiple gastric polyposis.

 

ndoscopy Polypectomy of Adenomatous Gastric Polyp

Endoscopy Polypectomy of Adenomatous Gastric Polyp.

Symptomatic gastric polyps should be removed preferentially when they are detected at the initial diagnostic endoscopy Polypectomy not only provides tissue to determine the exac thistopathologic type of the polyp, but also achieves radical treatment.

Gastric polyps may be single or multiple, and pedunculated or sessile in form. It is rare for a gastric polyp to grow to more thata few centimetres in diameter. Generally, they are asymptomatic but can produce haemorrhage, abdominal pain or obstruction ofthe pyloric canal. Usually a gastric polyp is an incidental findings on radiological or endoscopic investigation. They probably account for a very small proportion of gastric carcinomas but should nevertheless receive regular endoscopic follow-up.

Treatment is via endoscopic excision biopsy. Submucosal polyps,although not necessarily malignant, cannot be resectedendoscopically. However, endoscopic ultrasound may be ameans of surveillance of these lesions.

 

Gastric stalked polyp.

Video Endoscopic Sequence 1 of 4.

This image and the video clip display the stalked polyp.

Hyperplastic foveolar glands and inflamed, edematous lamina propria are the hallmarks of this lesion. Surface erosion is common and reactive inflammatory and regenerative epithelial changes are frequent.


Gastric Polyp

Video Endoscopic Sequence 2 of 4.

An endoscopy polypectomy is observed.

 

Gastric Polyp

Video Endoscopic Sequence 3 of 4.

The pedicle is being cauterized.

 

Gastric Polyp

Video Endoscopic Sequence 4 of 4.

The pedicle is being cauterized.

 

Gastric Polyp.

Video Endoscopic Sequence 1 of 7.

Gastric Polyp.

A 91 year-old female that six weeks previously had an giant ulcer, in this occasion an subsequent endoscopy was performed, in the video clip the scar of the ulcer is observed.

See the video sequence of that giant ulcer.

 

Endoscopy of Gastric Polyp.

Video Endoscopic Sequence 2 of 7.

Endoscopy of Gastric Polyp.

The gastric polyps observed using a magnifying endoscope.

 

Endoscopy of Gastric Polyp.

Video Endoscopic Sequence 3 of 7.

Endoscopy of Gastric Polyp.

More images and video clips of magnifying endoscopy.

 

Endoscopy of Gastric Polyp.

Video Endoscopic Sequence 4 of 7.

Endoscopy of Gastric Polyp.

More images and video clips of magnifying endoscopy.

 

Endoscopy of Gastric Polyp.Endoscopy of Gastric Polyp.

Video Endoscopic Sequence 5 of 7.

Endoscopy of Gastric Polyp.

Magnifying endoscopy and with methylene blue. Chromoendoscopy involves the topical application of stains or pigments to improve tissue localization, characterization, or diagnosis during endoscopy.

 

Endoscopy of Gastric Polyp.

Video Endoscopic Sequence 6 of 7.

The image and the video display the catheter spraying the methylene blue. Chromoendoscopy. Chromoendoscopy has been applied in a variety of clinical settings and throughout all gastrointestinal tract segments that are accessible to the endoscope. Interest has been renewed in recent years in part because of the development of new technologies such as endoscopic mucosal resection and photodynamic therapy, which require precise visual tissue characterization.

Endoscopy of Gastric Polyp.

Video Endoscopic Sequence 7 of 7.

Another image and video clip of the chromoendoscopy.

 

 

 

 

 

 

 

 

 

 

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