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Video Endoscopic Sequence 1 of 20.
Giant Multilobulated Gastric Polyp
This 65 year-old woman, presented this asymptomatic large
mass discovered as an incidental finding at an endoscopic
examination.
For more endoscopic details download the video clips by
clicking on the endoscopic images, wait to be downloaded
complete then press Alt and Enter; thus you can observe
the video in full screen.
All endoscopic images shown in this Atlas contain
video clips.
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Video Endoscopic Sequence 2 of 20.
Large and Wide Stalk
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Video Endoscopic Sequence 3 of 20.
This picture shows a large multilobulated polyp located in the proximal gastric body.
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Video Endoscopic Sequence 4 of 20.
Zoom Endoscopy
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Video Endoscopic Sequence 5 of 20.
A polypectomy begin to be performed
A dilution of adrenaline with 1/20.000 in dextrosa 50% was
injected in the base of the wide pedicle.
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Video Endoscopic Sequence 6 of 20.
Application of hemoclips.
Resection of a pedunculated polyp with prophylactic
hemoclips. A: pedunculated polyp and thick pedicle.
hemoclips have been used prophylactically
for thick-pedicle polyps prior to resection with an
endoscopic snare.
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Video Endoscopic Sequence 7 of 20.
Endoscopic clip ligation of polyp stalk to prevent bleeding
after snare polypectomy.
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Video Endoscopic Sequence 8 of 20.
Again A dilution of adrenaline with 1/20.000 in dextrosa 50
% is injected in the base of the wide pedicle.
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Video Endoscopic Sequence 9 of 20.
Metallic hemoclips have been endoscopically placed in the
gastrointestinal tract for the treatment of bleeding lesions
and closure of perforation. A further potential application
is the ligation of the pedunculated polyps prior to
polypectomy as a prophylactic measure to prevent
bleeding.
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Video Endoscopic Sequence 10 of 20.
Being removed with a snare around its large stalk. A rapid
cut current was applied to prevent burning at the clip site.
In the video clip, note the traction used to avoid
transmural injuries.
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Video Endoscopic Sequence 11 of 20.
The large mass has been removed endoscopicaly.
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Video Endoscopic Sequence 12 of 20.
With the help with this basket, the resected mass is being
retrieved.
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Video Endoscopic Sequence 13 of 20.
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Video Endoscopic Sequence 14 of 20.
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Video Endoscopic Sequence 15 of 20.
Status post polypectomy,
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Video Endoscopic Sequence 16 of 20.
Macroscopic image of the specimen.
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Video Endoscopic Sequence 17 of 20.
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Video Endoscopic Sequence 18 of 20.
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Video Endoscopic Sequence 19 of 20.
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Video Endoscopic Sequence 20 of 20.
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Video Endoscopic Sequence 1 of 14.
This is the case of a 62 year-old male with two
hyperplasic polyps and one tiny ulcerated lesion at the
pre-piloric antrum of the lesser curvature. One of the
polyps was located in the gastroesofagic junction, and the
other in the antrum. By biopsies hyperplasic nature was
confirmed.
We decided to use the strangulate method with rubber
bands instead of the traditional endoscopic polypectomy.
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Video Endoscopic Sequence 2 of 14.
Contrast Indigo Carmine Chromoscopy.
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Video Endoscopic Sequence 3 of 14.
In this image as well as the video is observed the polyp
of the gastroesofagic junction.
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Video Endoscopic Sequence 4 of 14.
The polyp at the antrum.
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Video Endoscopic Sequence 5 of 14.
The therapeutic treatment with the rubber bands
is initiated.
Endoscopic ligation is highly effective in obliterating polyps.
The use of a multibander device for endoscopic
polypectomy is technically feasible and safe, and its use
results in more rapid ablation of gastric polyps.
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Video Endoscopic Sequence 6 of 14.
Two rubber bands have been placed at the stalk.
Endoscopic band ligation for bleeding small-bowel vascular
lesions has been reported as safe and efficacious based on
small case series. There have been several other published
case reports of band ligators used for bleeding lesions,
usually Dieulafoy's lesions, in the stomach, the proximal
small bowel, and the colon. In addition, this method has
been used for postpolypectomy bleeding stalks.
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Video Endoscopic Sequence 7 of 14.
Other two bands were placed to the polyp of the
gastroesofagic junction.
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Video Endoscopic Sequence 8 of 14.
Strangulating the mucosa of the ulcerated lesion of
the antrum.
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Video Endoscopic Sequence 9 of 14.
In the image and the video are observed two polyps that
have been ligated.
Historically, in the pre-endoscopic era, the patients with
polyps of upper digestive tract were treated with surgical
resection; the patients with low risk did not operate unless
a change in size of the polyp noticed or malignant
degeneration in the radiological studies were suspected.
In 1968, the first report of a successful endoscopic gastric
polypectomy was published and, as of this moment, the
therapeutic approach to these injuries changed radically.
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Video Endoscopic Sequence 10 of 14.
The polyp of the cardia with two bands.
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Video Endoscopic Sequence 11 of 14.
Another image and video of the strangled polyps.
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Video Endoscopic Sequence 12 of 14.
On the following day, approximately 30 hours later, a new
endoscopy was made, observing the effectiveness of this
method.
Rest of medicines are observed adhered.
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Video Endoscopic Sequence 13 of 14.
The necrosis caused by the bands is demonstrated.
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Video Endoscopic Sequence 14 of 14.
In the case of the polyp of the cardia the polyp in almost its
totality has been only given off, observing only the two
bands in stalk.
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Video Endoscopic Sequence 1 of 6.
Hyperplastic Gastric Polyposis.
For more endoscopic details download the video clips by
clicking on the endoscopic image.
All endoscopic images shown in this Atlas contain a video
clip. We recommend seeing the video clips in full screen
mode.
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Video Endoscopic Sequence 2 of 6.
Many hyperplastic polyps are found incidentally on
gastroscopy. Physical findings are not specific.
Hyperplastic polyps are by far the most common histologic
type, and they can vary in location, number, and size. Most
are less than 2 cm. Although these polyps harbor no
malignancy, they may be accompanied by atrophic gastritis,
which predisposes the nonpolypoid mucosa to malignant
transformation.
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Video Endoscopic Sequence 3 of 6.
Hyperplastic polyps are the most frequently encountered
subtype of gastric polypoid lesions. They are usually
associated with chronic gastritis or H pylori gastritis.
They may harbour adenomatous changes or dysplastic foci.
Therefore, endoscopic polypectomy seems as a safe and
fast procedure for both diagnosis and treatment of gastric
polypoid lesions at the same session.
In addition, edematous mucosa may appear misleadingly
as a polypoid lesion in some instances and it can be ruled
out only by histopathologic examination.
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Video Endoscopic Sequence 4 of 6.
Numerous fundic gland polyps in the gastric corpus.
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Video Endoscopic Sequence 5 of 6.
Chromoendoscopy with indigo carmin.
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Video Endoscopic Sequence 6 of 6.
More images and video clips of this case of multiple
gastric polyposis.
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Video Endoscopic Sequence 1 of 8.
Hyperplastic Polyp.
This 30 year old female, presented with a large mass.
One year previously, this lesion was small, we wanted to
snare it but patient did not show up, at that time the
biopsies reveled a hyperplastic polyp.
Argon Plasma Coagulator was used as a therapeutical
approach.
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Video Endoscopic Sequence 2 of 8.
Chromoendoscopy with indigo carmin.
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Video Endoscopic Sequence 3 of 8.
The image and the video clip display the extension of
the large mass.
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Video Endoscopic Sequence 4 of 8.
Three months after a follow up endoscopy was performed.
Status post coagulation with argon plasma coagulator is
observed. This mass has been diminished in size.
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Video Endoscopic Sequence 5 of 8.
Another image and video clip.
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Video Endoscopic Sequence 6 of 8.
A new treatment with argon plasma coagulator is being
performed.
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Video Endoscopic Sequence 7 of 8.
This image and the video clip show the coagulation with
argon plasma coagulator.
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Video Endoscopic Sequence 8 of 8.
Appearance post APC.
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Endoscopy Polypectomy of Adenomatous Gastric Polyp.
Symptomatic gastric polyps should be removed preferentially
when they are detected at the initial diagnostic endoscopy
Polypectomy not only provides tissue to determine the exact
histopathologic type of the polyp, but also achieves radical
treatment.
Gastric polyps may be single or multiple, and pedunculated or
sessile in form. It is rare for a gastric polyp to grow to more that
a few centimetres in diameter. Generally, they are asymptomatic
but can produce haemorrhage, abdominal pain or obstruction of
the pyloric canal. Usually a gastric polyp is an incidental findings
on radiological or endoscopic investigation.
They probably account for a very small proportion of gastric
carcinomas but should nevertheless receive regular endoscopic
follow-up.
Treatment is via endoscopic excision biopsy. Submucosal polyps,
although not necessarily malignant, cannot be resected
endoscopically. However, endoscopic ultrasound may be a
means of surveillance of these lesions.
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Video Endoscopic Sequence 1 of 4.
This is the case of a 57 year old female with a large
ulcerated hyperplasic polyp of the gastric cardias,
presented with hematemesis and melena.
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Video Endoscopic Sequence 2 of 4.
This image and the video clip display the stalked polyp.
Hyperplastic foveolar glands and inflamed, edematous
lamina propria are the hallmarks of this lesion. Surface
erosion is common and reactive inflammatory and
regenerative epithelial changes are frequent.
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Video Endoscopic Sequence 3 of 4.
An endoscopy polypectomy is observed.
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Video Endoscopic Sequence 4 of 4.
The pedicle is being cauterized.
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Video Endoscopic Sequence 1 of 7.
Gastric Polyp.
A 91 year-old female that six weeks previously had an
giant ulcer, in this occasion an subsequent endoscopy was
performed, in the video clip the scar of the ulcer is
observed
See the video sequence of that giant ulcer.
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Video Endoscopic Sequence 2 of 7.
The gastric polyps observed using a magnifying endoscope.
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Video Endoscopic Sequence 3 of 7.
More images and video clips of magnifying endoscopy.
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Video Endoscopic Sequence 4 of 7.
More images and video clips of magnifying endoscopy.
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Video Endoscopic Sequence 5 of 7.
Magnifying endoscopy and with methylene blue.
Chromoendoscopy involves the topical application of stains
or pigments to improve tissue localization, characterization,
or diagnosis during endoscopy.
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Video Endoscopic Sequence 6 of 7.
The image and the video display the catheter spraying the
methylene blue. Chromoendoscopy.
Chromoendoscopy has been applied in a variety of clinical
settings and throughout all gastrointestinal tract segments
that are accessible to the endoscope. Interest has been
renewed in recent years in part because of the development
of new technologies such as endoscopic mucosal resection
and photodynamic therapy, which require precise visual
tissue characterization.
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Video Endoscopic Sequence 7 of 7.
Another image and video clip of the chromoendoscopy.
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