case_images: PMC11803858_01
case_images: a, b, c. A 1.5 cm prepyloric polyp was removed via endoscopic mucosal resection (EMR); d, e, f. a recurrent 2 cm polyp was found on esophagogastroscopy 1 year later. An EMR of the recurrent polyp was performed; g, h, i. another 2.5 cm polypoid lesion was found again via esophagogastroscopy 1 year later at the same site. EUS indicated a mucosal lesion with severe submucosal fibrosis.
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case_images: PMC11803858_01_gr1.jpg
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case_images: A 66-year-old man underwent EMR of a 1.5 cm prepyloric polyp (Fig. 1a, b, c). EMR of the recurrent polyp was performed, and pathology revealed a foveolar-type adenoma with low-grade dysplasia (Fig. 1d, e, f), margin was close to the lesion. Another 2.5 cm polypoid lesion was found via esophagogastroscopy 1 year later at the same site (Fig. 1g, h, i).
case_images: a. The distended stomach underneath the wound was sutured to the abdominal wall with four absorbable sutures; b, c, d. a 2.5 cm longitudinal incision at the anterior gastric wall was made, and a single-port device with four trocars (two 12 mm and two 5 mm) was inserted into the gastric cavity; e, f. the anterior gastric incision was closed with interrupted suture after completion of the laparoscopic procedure.
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case_images: PMC11803858_01_gr2.jpg
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case_images: The distended stomach underneath the wound was sutured to the abdominal wall using four absorbable sutures (Fig. 2a). A 2.5 cm longitudinal incision was made at the anterior gastric wall, and a single-port device with four trocars (two 12 mm and two 5 mm) was inserted into the gastric cavity (Fig. 2b, c, d). The anterior gastric incision was closed with interrupted sutures using 4-0 Mathon sutures (Fig. 2e, f).
case_images: a. Intragastric laparoscopy showing a well-visualized mucosal legion in the prepyloric region; b. the mucosa was cut open 5 mm from the edge of the polyp with an electric hook; c, d. a stitch was made in the normal mucosa near the polyp to aid in exposure by lifting during submucosal dissection; e. an ultrasonic dissector was used for dissection when the lifting tension was insufficient; f. the peri-pyloric mucosa was preserved during dissection to prevent postoperative pyloric deformation or stenosis; g. the gastric defect after dissection was intact without perforation. It was not sutured to avoid stretching of the gastric wall and potentially causing pyloric deformation; h. the size of the specimen was 25 mm x 20 mm, and the gross margin was clear.
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case_images: PMC11803858_01_gr3.jpg
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case_images: The mucosal lesion was well-visualized in the prepyloric region (Fig. 3a), 5 mm from the edge of the polyp, and the mucosa was cut with an electric hook (Fig. 3b). A stitch was placed in the normal mucosa near the polyp, and suture lifting was employed to aid in mucosal exposure during dissection (Fig. 3c, d). An ultrasonic dissector was used when lifting tension was insufficient (Fig. 3e). Care was taken to protect the peripyloric mucosa during dissection to prevent postoperative pyloric deformation or stenosis (Fig. 3f). The gastric wall wound was observed to be intact without perforation, and suturing was avoided to prevent pylorus traction and deformation (Fig. 3g). The dimensions of the specimens were 25 x 20 mm (Fig. 3h).