Successful hemostasis and resection of a bleeding gastric polyp by endoscopic banding ligation in a uremic patient taking antiplatelet agent.

Ping-I Hsu,Kwok-Hung Lai,E-Ming Wang,Jin-Shiung Cheng,Rong-Jer Lai,Tsair-Fwu Lee,Feng-Woei Tsay

doi:10.1186/s40064-016-3499-0

Abstract

The modalities to treat bleeding polyps include electrocautery snare polypectomy, adrenaline injection, clipping, argon plasma coagulation and surgery. We hereby describe an endoscopic banding ligation method for the management of bleeding gastric polyp in a patient receiving antiplatelet therapy. A 66-year-old man presented with a five month-history of intermittent tarry stool passage, nausea and fatigue. He had a past history of peripheral arterial occlusive disease and non-insulin dependent diabetes mellitus with end stage renal disease, and regularly took antiplatelet agent (ticlopidine 100 mg thrice daily) for cardiovascular prophylaxis. On examination, the patient was grossly pale, ill in appearance, with a pulse of 110/min and blood pressure of 108/76 mmHg. Laboratory examination revealed hemoglobin of 7.8 g/dl. Endoscopic examination revealed a bleeding sessile polyp over the posterior wall of the antrum. Endoscopic banding ligation was carried out by a pneumoactivated esophageal variceal ligation device set. Bleeding stopped immediately following the procedure, and the patient recovered uneventfully. It is suggested that endoscopic banding ligation is a safe and effective technique for the treatment of bleeding gastrointestinal polyps in patients receiving antiplatelet therapy.

Highlights

Polyp or tumor bleeding is an uncommon cause of upper gastrointestinal hemorrhage (Van Leerdam 2008; Suo et al 2011; Lakhwani et al 2000)
Endoscopic ligation using suction equipment and rubber bands has been widely used in the management of bleeding esophageal varices (Cipolletta et al 1998; Wang et al 2014)
We applied endoscopic banding ligation (EBL) to treat a bleeding gastric polyp in a uremic patient who took antiplatelet agent for secondary prevention of cardiovascular disease. This is the first case with bleeding gastric polyp treated by EBL

Summary

Introduction

Polyp or tumor bleeding is an uncommon cause of upper gastrointestinal hemorrhage (Van Leerdam 2008; Suo et al 2011; Lakhwani et al 2000). The varices are automatically eradicated through the use of ligation In this case report, we applied endoscopic banding ligation (EBL) to treat a bleeding gastric polyp in a uremic patient who took antiplatelet agent for secondary prevention of cardiovascular disease. The distal end of the scope was set a transparent hood equipped with a pneumoactivated esophageal variceal ligation (EVL) device set (Sumitomo Bakelite Co., Tokyo, Japan). It was composed of an air feeding tube, a sliding tube and a rubber band. A follow-up endoscopy 3 months later revealed that both the ligated polyp and the rubber band had vanished (Fig. 1d)

Discussion

Conclusions