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LAPAROSCOPIC ASSISTED EXCISION OF GASTROESOPHAGEAL INFLAMMATORY FIBROTIC POLYP

Linda I Yala, MD1, Rami Lutfi, MD, FACS, FASMBS2, Lindsey Klingbeil, MD2. 1UIC-MGH General Surgery Residency, 2Mercy Hospital, Chicago, IL

INTRODUCTION: Gastric polyps include a wide spectrum of lesions with different histology, neoplastic potential, and management. 6% of upper gastrointestinal endoscopies will reveal a lesion. Typically, they are asymptomatic but their presence will warrant biopsy, guiding the next steps of management. Occasionally, adjuncts may provide only a partial picture of the diagnosis and therefore decisions in management must be made intraoperatively.

METHODS: We presented a 74-year-old male with multiple co-morbidities who presented after anemia and melanotic stools. An upper gastrointestinal endoscopy on prior admission only showed diffuse gastritis. Now, EGD showed a large, pedunculated polypoid lesion near the squamocolumnar junction. Biopsies were nonspecific. CT scan confirmed an isolated lesion with some gastrohepatic lymph node enlargement. Concern was for gastrointestinal stromal tumor or leiomyoma and the decision was made to remove it laparoscopically due to the location at the gastroesophageal junction, size, and description of a narrow base.

In the operating room, a hiatal hernia was noted and an intraoperative EGD confirmed vicinity of the mass relative to our planned dissection. We then proceeded using the same technique as we utilize for a hiatal hernia repair, identifying and preserving a replaced hepatic artery in the process. A gastrotomy was made, the mass was delivered from the stomach, and it was clear that what was described as a pedunculated lesion was actually wide based and firm, making us more concerned for malignancy. After partial resection and assessment in pathology, it was confirmed as a benign inflammatory fibroid polyp which was then resected in its entirety. We ensured the integrety of the posterior gastric wall and esophagus, closed the gastrotomy, and repaired the hiatal hernia repair. A leak test was negative. The patient’s post operative course was uneventful.

CONCLUSION: Vanek's tumor or inflammatory fibroid polyp (IFP) is a rare submucosal, mesenchymal tumor of the digestive tract. It accounts for about 0.1% of all gastric polyps and is most commonly localized to the gastric antrum. Depending on their size and location, IFPs can be associated with nonspecific symptoms. Endoscopic biopsies are often unhelpful and right diagnosis can be reached only with resection. Histopathological examination reveals the presence of spindle cells with eosinophilic infiltration. The appearance of IFP is pertinent to present as it raises suspicion for alternative more concerning diagnosis including GIST, cancer, or gastric lymphoma. The resection of IFPs has good clinical outcome.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95614

Program Number: V235

Presentation Session: Video Loop Day 2

Presentation Type: VideoLoop

51

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