Wayne State University, Detroit Medical Center Detroit, MI, United States
Tooba Tariq, MD1, Fadi Antaki, MD2, Kirthi Lilley, MD3 1Wayne State University, Detroit Medical Center, Detroit, MI; 2John D. Dingell VA Medical Center and Wayne State University, Detroit, MI; 3John D. Dingell VA Medical Center, Detroit, MI
Introduction: Limited data exists regarding treatment of pedunculated submucosal tumors. Endoscopic snare cautery polypectomy of these lesions is associated with an increased risk of post-polypectomy bleeding and bowel perforation.
Case Description/Methods: We herein report the case of an incidental, large, pedunculated, submucosal polyp in duodenum which was treated with ligation without resection. A 67-year-old man with history of ESRD (on peritoneal dialysis) was evaluated for refractory GERD. Esophagogastroduodenoscopy (EGD) revealed a submucosal mass in the third portion of the duodenum. The complete extent of the lesion could not be assessed. Enteroscopy was performed which showed a pedunculated submucosal polyp in the duodenum (third portion) with a large ( >15mm) and long ( >4cm) stalk. After epinephrine injection, an Endo-loop (detachable snare) was placed close to the base of the stalk. Given the size of the stalk, decision was made not to resect the polyp. The Endo-loop was left in order to cause necrosis leading to self-amputation of the polyp and hence the specimen was not retrieved. A repeat enteroscopy 2 months later showed a scar in the third portion of the duodenum with no evidence of the previous polyp. Biopsies of the scar revealed no neoplasia.
Discussion: Endo-loop ligation of large submucosal tumors is a safe and effective approach. The main limitation is the inability to retrieve tissue specimen and hence a definitive histopathologic diagnosis cannot be made.
Figure: Pedunculated, submucosal polyp in the third portion of duodenum
Disclosures: Tooba Tariq indicated no relevant financial relationships. Fadi Antaki indicated no relevant financial relationships. Kirthi Lilley indicated no relevant financial relationships.
Tooba Tariq, MD1, Fadi Antaki, MD2, Kirthi Lilley, MD3. P2540 - A Case of a Large, Pedunculated, Submucosal Duodenal Polyp Treated by Endo-Loop Ligation, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
