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Upper gastrointestinal bleeding following isolated gastric filiform polyp resection [Meeting Abstract]

Dornblaser, D W; Latorre, M; Liu, S; Perelman, A
Introduction: We present the case of an older male with acute onset melena five days following resection of a rare inflammatory gastric polyp despite hemostatic prophylaxis. Case Description/Methods: A 76-year-old man presented for an upper endoscopy for new onset early satiety and was incidentally found to have a gastric polyp along the lesser curvature. The polyp had a hyperemic fingerlike projection two centimeters in diameter which was biopsied, with findings consistent with hyperplastic polyp. A repeat endoscopy off aspirin was scheduled for polypectomy. In preparation for resection, diluted epinephrine was injected at the base of the polyp. Gastric polypectomy was performed with hot snare and two hemostatic clips were placed for bleeding prophylaxis. Five days later the patient presented with acute onset melena with a serum hemoglobin of 8.7 g / dL. He underwent repeat upper endoscopy and was found to have a gastric ulcer with a nonbleeding visible vessel at the site of the previous polypectomy and the previously placed hemostatic clips had fallen off. The area was injected with diluted epinephrine and six additional hemostatic clips were placed. The patient was discharged in stable condition. Histopathological examination revealed submucosal tissue containing chronic inflammation, dilated vessels, glandular cysts, lymphoid aggregate and hypertrophic smooth muscle fibers surrounded by an erosive, hyperplastic, reactive foveolar epithelium, a pathologic diagnosis most consistent with gastric filiform polyp.
Discussion(s): Filiform polyps are a unique subset of polyps that are typically encountered in patients with inflammatory bowel disease (IBD), however they can also be found in patients incidentally. The pathophysiology of this type of inflammatory polyp in patients without IBD remains unknown. Filiform polyps typically present in a non-syndromic polyposis fashion involving tens to hundreds of slender, threadlike projections that are usually found in the colon, most commonly the sigmoid colon. Isolated filiform polyps without IBD can be encountered, but are rarely discovered outside of the colon. The polyp is not thought to harbor any premalignant potential, however polypectomy should be performed if the pathology is unknown or if the polyp is of large diameter, as in this case. While prophylactic epinephrine and clips can be utilized to prevent post-polypectomy bleeding, given the highly vascularized core, these lesions may be prone to bleeding following resection despite these efforts.
EMBASE:636473368
ISSN: 1572-0241
CID: 5084272

Acute management of pancreatitis: the key to best outcomes

Olson, Erik; Perelman, Alexander; Birk, John W
Acute pancreatitis (AP) accounts for over 230 000 US and 28 000 UK hospital admissions annually. Abdominal pain is the most common presenting symptom in AP but may not reflect severity. The clinical challenge is identifying the 20% of patients in whom AP will be severe. We summarise the common aetiologies, the risk stratification strategies including the simplified Bedside Index for Severity in Acute Pancreatitis, acute management approaches in the initial presentation setting, conditions for using advance imaging and opinions on antibiotic use. Some warning signs of impending complications are also discussed.
PMID: 31123175
ISSN: 1469-0756
CID: 4552482