S-33 Upper gastrointestinal bleeding from the malignant gastric polyp

Gastric hyperplastic polyps are usually found incidentally on upper gastrointestinal endoscopy. They can cause problems such as bleeding and gastric outlet obstruction and may harbor adenocarcinoma when the size of polyp is large. A 65-year-old male presented with melena. He had been received warfarin 4mg per day for atrial fibrillation. Initial vital sign was 100/70-120-20-36.6. Laboratory data showed Hemoglobin 11.2 g/dL, PT (INR) 2.0, BUN 51.2 mg/dL. Emergency upper endoscopy revealed 1.0 cm sized semipedunculated polyp with bleeding at the lesser curvature of distal antrum (Fig.A). After epinephrine injection, bleeding was stopped. Next day, second look endoscopy did not show active bleeding from the polyp. On 4th hospital day, PT (INR) was normalized and we removed the polyp by snare polypectomy (Fig.B). An ulceration with small protruding vessel was noted at the backside of polypectomy specimen and thought to be a bleeding focus (Fig.C). Histopathologic result revealed hyperplastic polyp with focal well differentiated adenocarcinoma in the ulcerated area (Fig.D) and the lateral resection margin was involved by carcinoma. We performed additional endoscopic resection by endoscopic submucosal dissection method at previous polypectomy site after scar formation. Histopathologic result demonstrated no remnant cancer. This is a rare case of upper gastrointestinal bleeding from gastric hyperplastic polyp, which was revealed as adenocarcinoma in polypectomy specimen. When bleeding gastric polyps are found, the possibility of malignancy should be considered.