Endoscopic Mucosal Resection for Early Gastric Cancer Arising in a Small Adenomatous Polyp

Case Report

Austin J Gastroenterol. 2015;2(3): 1042.

Endoscopic Mucosal Resection for Early Gastric Cancer Arising in a Small Adenomatous Polyp

Gerada J1*, Fenech V1, Attard J2 and Pocock J1

1Division of Gastroenterology, Mater Dei Hospital, Malta

2Department of Pathology, Mater Dei Hospital, Malta

*Corresponding author: Dr. Jurgen Gerada MD MRCP MSc, Mater Dei Hospital, Msida, Malta, Europe

Received: December 07, 2014; Accepted: March 09, 2015; Published: March 11, 2015


Adenoma; Endoscopic Mucosal Resection; Gastric Cancer; Polyp


Gastric cancer is the sixth commonest cancer and the fourth commonest cause of cancer-related deaths. Despite a gradual decline in the worldwide incidence of gastric cancer, there has been a relative increase in the incidence of tumors of the oesophago-gastric junction and gastric cardia. Advances in technology has made it possible for improvements in diagnostic and therapeutic endoscopy, and staging with cross-sectional imaging. Moreover, the increase in the elderly population with multiple co-morbidities is presenting significant clinical management challenges.

We hereby present an elderly lady, who was found to have early gastric carcinoma in the antrum of the stomach, arising from a small adenomatous polyp and treated with Endoscopic Mucosal Resection (EMR). This case highlights the successful endoscopic treatment with EMR in early gastric cancer, especially in patients who would not be fit for surgery. It also highlights the progression of gastric adenomas to carcinoma even in small polyps, when classically this is associated with larger polyps.

Case Presentation

An 87 year old lady, with a history of coronary artery bypass graft, ischaemic heart disease, hypertension and chronic renal failure, presented with a 3 day history of melaena and subsequent anaemiarelated decompensated congestive heart failure. She did not report any other associated upper or lower gastrointestinal symptoms. She had been taking dual antiplatelet therapy and a once daily proton pump inhibitor, amongst other medications for hypertension. Family and social histories were unremarkable. Clinical examination revealed pallor, tachycardia and hypotension, but failed to reveal any abdominal masses or scars. Digital rectal examination confirmed melaena. Blood investigations showed a normochromic normocytic anaemia (haemoglobin 7.2g/dL (11.5-16.5g/dL)), a low normal ferritin of 22ng/mL (range 10-291ng/mL), iron of 7.15umol/L (range 5.8-34.5umol/L) and transferrin saturation of 11% (20-50%). Her haemoglobin had been normal 3 months previously. Following discontinuation of antiplatelet therapy, administration of blood products and resuscitation of the patient, an upper Gastrointestinal Endoscopy (OGD) was performed. This showed a small (6mm), lobulated, sessile, ulcerated antral polyp, with surrounding erythema and few superficial types of erosion (Figure 1). Histology showed the polyp to be adenomatous with low grade dysplasia with foci suspicious for malignancy. Surrounding antral mucosa showed congested lamina propria, prominent foveolar hyperplasia and intestinal metaplasia. No Helicobacter pylori organisms could be seen. A computed tomography of the trunk revealed no evidence of metastasis. Endoscopic ultrasound could not be possible, as this is unavailable in our centre.

Citation: Gerada J, Fenech V, Attard J and Pocock J. Endoscopic Mucosal Resection for Early Gastric Cancer Arising in a Small Adenomatous Polyp. Austin J Gastroenterol. 2015;2(3): 1042. ISSN:2381-9219