Clinical and endoscopic features of gastric pyogenic granuloma

SummaryBackgroundPyogenic granuloma (PG) is a polypoid form of capillary hemangioma. This study aimed to analyze the clinical and endoscopic features of gastric PG.MethodsWe retrospectively reviewed nine patients with gastric PGs who were evaluated by esophagogastroduodenoscopy and diagnosed by pathological study at the Chang Gung Medical Center (Taoyuan, Taiwan) between 2000 and 2009. Demographic data, clinical presentations, endoscopic findings, treatment, and outcome were collected and analyzed.ResultsThe median age of the study patients was 62 years (range, 40–73 years) with a female preponderance. The most common symptom at presentation was overt gastrointestinal bleeding, followed by anemia and epigastralgia. Two patients were asymptomatic at diagnosis. The most common underlying diseases were liver cirrhosis [5 (56%) patients] and hypertension [5 (56%) patients]. Five (56%) cases of gastric PGs originated at the site of prior ulcer lesions. Most gastric PGs were solitary [7 (78%) patients] and located in the antrum [8 (89%) patients]. The gastric PGs typically appeared morphologically as smooth protruding hyperemic lesions with adherent white or yellow deposits. One patient received an endoscopic mucosal resection with complete excision of the lesion. Another patient received surgical intervention. Four gastric PG lesions were stationary or regressed with conservative management.ConclusionOvert gastrointestinal bleeding was the most common clinical presentation in patients with gastric PG. Gastric ulcers were the most common precursors of PG with the antrum being the most frequent site involved. Gastric PGs were characteristically protruding hyperemic lesions with adherent exudates. Conservative treatment may be considered for asymptomatic PG patients with major comorbidities. Endoscopic resection may be offered to patients with symptoms.