From the Guidelines
Management of a bleeding gastric polyp requires prompt endoscopic intervention as the first-line treatment. The initial approach should focus on hemodynamic stabilization with intravenous fluids and blood transfusions if necessary, followed by urgent upper endoscopy to identify and treat the bleeding polyp 1. Endoscopic techniques such as epinephrine injection, thermal coagulation, or mechanical methods like hemoclips or endoloops can be employed to achieve hemostasis.
Key Considerations
- For larger polyps, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) may be necessary.
- Following successful hemostasis, patients should receive proton pump inhibitor therapy.
- Histological examination of the removed polyp is crucial to rule out malignancy.
- If endoscopic management fails, interventional radiology for embolization or surgical intervention, as outlined in guidelines for non-variceal upper gastrointestinal haemorrhage 1, may be necessary.
Additional Measures
- The underlying cause of the polyp, such as H. pylori infection, should be addressed to prevent recurrence.
- Follow-up endoscopy is recommended to ensure complete healing and to monitor for new polyp formation, typically within 3-6 months depending on the initial findings. Given the potential for rebleeding and the importance of individualized management based on patient factors and endoscopic findings, as suggested by guidelines 1, a tailored approach considering the patient's age, comorbidity, and specific endoscopic findings is essential for optimal outcomes.
From the Research
Management of Bleeding Gastric Polyp
The management of a bleeding gastric polyp involves several steps, including:
- Endoscopic evaluation to identify the source of bleeding and the type of polyp
- Endoscopic removal of the polyp, which can be diagnostic and therapeutic 2, 3
- Histopathologic examination of the removed polyp to rule out malignancy 2, 4
- Consideration of the possibility of malignancy, especially in cases of hyperplastic polyps with ulceration or bleeding 2, 3
Endoscopic Approaches
Endoscopic approaches for managing bleeding gastric polyps include:
- Snare polypectomy, which can be used to remove pedunculated polyps 2
- Endoscopic submucosal dissection, which can be used to remove larger polyps or those with a higher risk of malignancy 2
- Endoscopic mucosal resection, which can be used to remove smaller polyps or those with low-grade dysplasia 4
Surgical Intervention
Surgical intervention may be necessary in cases where:
- Endoscopic removal is not possible or has failed 3
- The polyp is large or has a high risk of malignancy 5
- There is evidence of gastric cancer or other complications 5
Follow-up Evaluation
Follow-up evaluation is necessary to monitor for recurrence of bleeding or development of gastric cancer, especially in cases where the polyp has been removed endoscopically 5. Annual endoscopic control may be necessary for patients with a history of gastric polyps, especially those with hyperplastic or adenomatous polyps 5.