The OMED Committee for "Electronic Communications" is starting a program specifically designed to stimulate the participation of endoscopists throughout the world to use electronic communication facilities for the presentation of interesting or unusual cases in the OMED website: endocopic quitzes will also be wellcome. The proposals may be sent to the Secretary of the Committee, Dr. A. Grassi, at the OMED e-mail address (omed@uni.net). The cases accepted will be displayed for the period of time and are open to debates.

We hope this initiative will further improve the relashionships within the endoscopic community represented worldwide by OMED.

The case: man of 32 years , referring epigastric pain since three months and some episodic heartburn. In his family some relatives were affected by peptic ulcer disease. No therapy was in progress. No other significant symptoms were referred.

The patient was submitted to gastroscopy. Endoscopic report: at the anterior wall of the gastric body it is observed a protruding submucosal lesion, with a diameter of 3 cm : the mucosa at this level is of normal appearance and without ulceration (Fig.1). No abnormalities in the oesophagus, other parts of the stomach and duodenum.

The lesion was investigated by endosonography and showed an hyperechogenic area of 3 cm originating from the muscolaris propria, without infiltration of the muscolaris, protruding into the lumen, and raising the mucosal layers without infiltration (Fig. 2).

It was decided to submit this lesion to endoscopic polypectomy with snare. The polypectomy was uneventful and the lesion was retrieved for pathology examination (Fig. 3). The hystologic report showed a submucosal leyomioma.

Endoscopic controls were performed after 4 day and a month: a scar was present at the first exam (Fig. 4) and a complete recovery in the area of polypectomy with only a minimal residual scar at the second one (Fig.5).

Has the endoscopic polypectomy to become a rule for the treatment of this kind of lesions ?

Ishii T; Kuyama Y; Obara M; Yamanaka M; Imamura T. Gastrointestinal stromal tumor of the stomach.Intern Med 1997 Jun;36(6):392-7

 

Wenger FA; Jacobi CA; Zieren HU. Diagnosis and therapy of leiomyoma of the upper
gastrointestinal tract. Langenbecks Arch Chir 1996;381(4):221-4

Goenka MK; Bhasin DK; Singh V; Poddar U; Das A; Sriniwas V; Singh K. Gastric stromal tumor: treatment by snare polypectomy. Trop Gastroenterol 1996 Apr-Jun;17(2):43-6

Presented by Prof. J.R. Armengol Miro' (Spain) and Dr. A. Grassi (Italy)