Slaying the Hydra: Two Cases Series of Complex Gastric Polypectomy

Introduction: Gastric polyps are incidental findings on upper gastrointestinal endoscopy,with 1-3% prevalence in such exams [1]. A double-headed polyp is a rare finding during endoscopic examination [2] [3]. Guidelines recommend endoscopic mucosal resection for lesions exceeding 10 mm.

Cases presentation: In this report, we describe two cases of complex gastric polypectomy involving two-headed hyperplastic polyps. In the first case,endoscopic examination with a distal attachement of the gastric antrum revealed two large polyps:one pedunculated polyp prolapsing into the duodenal bulb and a second smaller sessile polyp at the base of the stalk, both with hyperplastic features. After adrenaline injection of the stalk base, the larger polyp was resected with a hot snare, followed by removal of the smaller polyp in a similar fashion. Hemostasis was ensured by clip placement.In the second case, endoscopic examination with a distal attachment revealed two large, pedunculated polyps with thick stalks situated in proximity to the pylorus, intermitently prolapsing into the duodenal bulb; both polyps presented ulceration and hyperplastic features. After adrenaline injection of the stalk base, both polyps were removed using continuous coagulation effect. Mild bleeding from one stalk was controlled with mechanical hemostasis.

Conclusion: This cases underscore the pivotal role of distal attachments in improving visualization, stabilizing the resection site and facilitating control over potential bleeding, while also highlighting the effectiveness of endoscopic techniques for resecting large double headed polyps and hemostasis during complex procedures.

Publication History

Article published online:
27 March 2025

• References

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