出血を来した胃過誤腫性内反性ポリープに対して ESD を施行した 1 例

A 45-year-old man undergoing hemodialysis was referred for melena. Upper gastrointestinal endoscopy revealed a 20-mm submucosal tumor, likely aberrant pancreas, at the gastric antrum. However, the bleeding point was not detected. Three days later, the patient experienced melena again, and the anemia worsened (hemoglobin, 4.9 g/dL). Another upper gastrointestinal endoscopy was performed, and a clot was found at the opening of the submucosal tumor, leading to suspicion of bleeding from the aberrant pancreas. Despite conservative treatments, the anemia worsened, and blood transfusions were frequently required. EUS revealed a submucosal tumor in the third layer, and ESD was performed for hemostasis. Pathological examination of the resected specimen led to the diagnosis of a hamartomatous inverted polyp, with the bleeding point suspected to have been an ulcer on the inverted mucosa. Hamartomatous inverted polyps are benign tumors that can cause bleeding, and ESD could be an option for hemostasis in certain cases.