Dead-end stomach: a giant and pedunculated gastric pyloric gland adenoma conditioning gastric outlet obstruction and anemia

Dear editor, We present the case of a 69-year-old female undergoing esophagogastroduodenoscopy for iron-deficiency anemia investigation. She reported intermittent bloating, nausea and vomiting. A pedunculated polyp was identified arising from greater curvature middle gastric body, with long fibroelastic stalk (30mm) 60mm congestive head that prolapsed towards pyloric ring, causing complete outlet obstruction (GOO). An en-block polypectomy performed. intraprocedural oozing bleeding large visible vessel at residual managed using endoloop®. Histo-immunohistochemistry showed R0-resection mixed-type gland adenoma (PGA) positive MUC-5AC MUC-6 mucins, in surrounding H. pylori-negative non-atrophic chronic gastritis. became asymptomatic resolution. Adenomas account up to 10% polyps. Histologically, they are categorized into intestinal, foveolar, oxyntic types (1). PGA is rare subtype, accounting less than 3% all polyps (2). PGAs usually solitary occur association autoimmune gastritis, pylori chemical gastritis normal background mucosa has also been described (35.8%) (3). devoid apical mucin cap label by both Choi et al. (3) defined three immunohistochemical phenotypes: pure pyloric-type (25.4%), strong expression; predominant foveolar-type (3%), diffuse expression but ?10% no foveolar differentiation; (61.2%), variable MUC-5AC/MUC-6 expression. Most asymptomatic, clinically significant because their potential malignant transformation (12-47%) complications, including gastrointestinal (1, 3). GOO rare, symptoms intussusception (ball-valve-syndrome) (4, 5). management challenging, depending on size, morphology location. This illustrates successful endoscopic resection as minimally invasive procedure doubly complicated PGA.