S2174 Treatment of Hyperplastic Gastric Polyps With Band Ligation for Transfusion Dependent Iron Deficiency Anemia

Abstract

INTRODUCTION: Hyperplastic gastric polyps (HGP) are a common incidental finding on Esophagogastroduodenoscopy (EGD). However, they are an infrequent cause of iron deficiency anemia (IDA) requiring transfusion. Prior case studies have shown the potential of band ligation as a treatment option for bleeding HGP. This case outlines the successful use of band ligation in this rare case of bleeding HGP causing transfusion dependent iron deficiency anemia. CASE DESCRIPTION/METHODS: A 78-year-old female, with a history of HGP status post polypectomy two years prior to admission, coronary artery disease with recentcardiac stent placement and initiation of dual anti-platelet therapy (DAPT), presented with melena and fatigue. She presented hemodynamically stable and her labs were remarkable for acute on chronic IDA requiring recurrent transfusions. EGD was notable for multiple 4–7 mm friable sessile polyps with small ulcerations found in the gastric body. No therapeutic intervention was performed as decision to conservatively support the patient was made in the setting of the bleeding risks on DAPT. She was discharged with a stable hemoglobin and future endoscopic treatment once DAPT was able to be held. One week later she returned with similar complaints and was found to have recurrent acute on chronic IDA. Repeat EGD was significant for multiple sessile polyps with stigmata of recent bleeding and ulcerations. Due to her refractory anemia requiring transfusions, it was decided to treat with targeted band ligation of 5 HGP with the most bleeding potential. She again presented 2 days after discharge with similar complaints and recurrent anemia. Push enteroscopy showed blood from an indeterminate source as well as the 5 previously banded polyps without signs of bleeding. Her symptoms resolved and her hemoglobin continued to improve. Four months later her hemoglobin remained stable and she continued to be asymptomatic. DISCUSSION: This case demonstrates the potential of band ligation as a safe and effective treatment option for recurrent bleeding HGP. Compared with a 7.2% bleeding complication rate post-polypectomy a previous trial showed that band ligation had a 0% bleeding complication rate.1,2 We also see the effects of band ligation leading to ulceration of the site and eventual scarring. Consistently, Lo CC et al. showed that all polyps dropped off following ligation. Band ligation is a promising low-risk treatment option for recurrent bleeding HGP and requires further investigation.Figure 1.: Multiple, friable hyperplastic gastric polyps in the gastric body.Figure 2.: Band ligation of hyperplastic gastric polyps.Figure 3.: Area of scarring status post band ligation of hyperplastic polyps.