The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 257
Poster Session
PS 1065 Gastroenterology (Gastrointestinal Tract) A Case of Gastric Inverted Hyperplastic Polyp
Sang Youn Lim1, Jong Jae Park1, Beom Jae Lee1, Jae Seon Kim1, Young Tae Bak1 Korea University Guro Hospital, Korea1
Introduction: Gastric inverted hyperplastic polyp (IHP) is a rare type of gastric polyp, and is characterized by the downward growth of hyperplastic mucosa into the sub- mucosal layer, usually resembling a submucosal tumor macroscopically. Gastric IHP is diffi cult to diagnose accurately because of its inversion into the submucosal layer, so diagnosed by the pathological characteristics of the tumor. The pathogenesis of gastric IHP remains unclear because reported cases are extremely rare. Here, we present the case of Gastric inverted hyperplastic polyp.
Case Report: A 37-year-old male was admitted to our hospital for gastric endoscopic submucosal dissection(ESD). He presented with two-months history of sore throat &
heartburn. Physical examination and laboratory data were not remarkable abnormal fi ndings. Endoscopic examination showed a 1.5cm-sized submucosal mass with cen- tral ulceration on greater curve of high body. Endoscopic ultrasonography showed a 1.5cm-sized, heterogenous echogenic mass originated from submucosal layer. Comput- ed tomography demonstrated a 1.9cm-sized polypoid lesion on posterior wall of high body in stomach that is suggestive of submucosal tumor such as GIST. On purpose of a diagnosis of gastric submucosal tumor, “En bloc” resection using ESD techniques was performed and the patient was discharged without any complications.The resected specimen, measuring 2.2*1.3cm, was a well-circumscribed, protruding mass covered with normal gastric mucosa. Histologically, the lesion consisted of mainly cystic dilated foveloar epithelium and proliferation of smooth muscle.
Discussion: Gastric IHP is pathologically defi ned by cystic dilated hypertrophic pseu- do-pylorus gland proliferation and smooth muscle located in the submucosal layer.
The pathogenesis of Gastric IHP remains unclear because reported cases are extremely rare. Although Gastric IHP is a benign tumor, approximately 20% of it coexist with precancerous or cancerous areas. Therefore, it is important to diagnose these polyps and we suggest En bloc resection using ESD techniques is recommended.
PS 1066 Gastroenterology (Gastrointestinal Tract) Clinical Characterstics and Outcomes of Angiodysplasia Presented as Upper Gastrointestinal Bleeding
Eun Sun Lim1, Woo Chul Chung1, Seok Jong Lee1, Dae Bum Kim1, Yoon Yung Chung1, Ji Min Lee1, Hae Jung Sung1, Kang-Moon Lee1
Department of Internal Medicine, The Catholic University of Korea, St. Vincent’s Hospital, Korea1
Background: Angiodysplasia is considered as the differential diagnosis of upper gas- trointestinal bleeding (UGIB), but the clinical features and outcomes associated with UGIB from angiodysplasia have not been characterized.
Methods: Between January 2003 and December 2012, a consecutive series of patients who had UGIB and admitted to St. Vincent’s hospital, the Catholic University of Korea were retrospectively analyzed. A total of 35 patients with bleeding from angiodyspla- sia were enrolled in this study. We compared the UGIB group from angiodysplasia with asymptomatic control group (incidental fi ndings of angiodysplasia during endoscopic examination in health screening center).
Results: When patients with UGIB from angiodysplasia were compared with asymp- tomatic control group, there were signifi cant differences of age, hemoglobin level, hematocrit, blood urea nitrogen, sodium, albumin, fasting blood sugar (FBS), location (body/ fundus) and size of the lesion (=1cm) in univariate analysis. Also, the history of diabetes (FBS = 126mg/dL or HbA1c = 6.5% or on medication) and medication history (anti-platelet agents, warfarin, NSAIDs, steroids) were different. In multivariate anal- ysis, there were signifi cant differences of the level of albumin, sodium, FBS, location and size of the lesion. The rate of clinical recurrence of UGIB from angiodysplasia was 14.2% (5/35).
Conclusions: When angiodysplasia was larger than or equal to 1cm or located in gas- tric body/ fundus, it was associated with UGIB. In patients with angiodysplasia, strict control of blood sugar and good general condition might reduce the risk of bleeding.
PS 1067 Gastroenterology (Gastrointestinal Tract) Spontaneous Gastric Intramural Hematoma Occurred in a Patient Taking Clopidogrel : A Case Report
Kwang Youn Kim1, Sung Eun Kim1, Ji Won Park1, Hyun Lim1, Ho Suk Kang1, Sung Hoon Moon1, Jong Hyuk Kim1, Choong Kee Park1
Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Korea1
Intramural hematoma of the gastrointestinal tract is a rare disease, especially in the stomach has been more rarely reported. Most gastric intramural hematomas are often related coagulopathy such as hemophilia, anticoagulation or spontaneous causes. We report a case of spontaneous gastric intramural hematoma in end-stage renal disase (ESRD) patient with hemodialysis, taking clopidogrel. A 52-year-old man admitted our hospital due to abdominal pain and hematemesis. He was a patient with ESRD under- going hemodialysis and has been taking a clopidogrel. Endoscopy was performed im- mediately. A 10cm-sized large hematoma covered with normal mucosa was observed at anterior wall of antrum. About 2.5 cm-sized active ulcer with adherent clot was found in the center of lesion which was pressed gently by biopsy forcep. Computed tomography showed an approximately 11 x 4 cm-sized huge intramural hematoma in anterior wall of gastric antrum. He received conservative treatment with proton pump inhibitor and total parenteral nutrition for 10 days. Although large ulcer was shown on follow-up endoscopy, gastric intramural hematoma was disappeared.
