S4353 Severe Anemia and Intermittent Dysphagia From a Benign Gastroesophageal Junction Hyperplastic Polyp

Introduction: Hyperplastic polyps are rare, benign gastric mucosal overgrowths, often found incidentally on endoscopy. Though they have a low risk of malignancy, hyperplastic polyps are frequently associated with Barrett’s esophagus if found at the gastroesophageal junction (GEJ). We report a case of intermittent dysphagia and severe anemia in a patient with a large, ulcerated hyperplastic polyp. Case Description/Methods: A 71-year-old woman with a past medical history including atrial fibrillation on apixaban and breast cancer in remission, presented with a 1-month history of progressive shortness of breath and intermittent dysphagia. Her initial workup revealed a hemoglobin of 6.8 g/dL and serum ferritin of 6 ng/mL, consistent with severe anemia. After receiving 2 units of packed red blood cells, her hemoglobin improved to 8.6 g/dL. An initial esophagogastroduodenoscopy (EGD) identified a 2 cm, sessile, villous-appearing polyp with surface ulceration at the GEJ. Biopsies at that time showed only chronic inflammation with no evidence of dysplasia or malignancy, and a subsequent computed tomography w/ contrast of the chest was negative for metastatic disease. Given her persistent symptoms, the patient underwent a therapeutic EGD for endoscopic submucosal dissection of the lesion. The polyp was demarcated, lifted with a submucosal injection, and successfully resected in 1 piece. The final pathology report confirmed the lesion was a hyperplastic gastric mucosal polyp, definitively negative for intestinal metaplasia, dysplasia, or carcinoma. Following the procedure, the patient reported complete resolution of her dysphagia and was prescribed a 4-week course of omeprazole with a recommendation for a follow-up EGD in 3 years. Discussion: Hyperplastic polyps of the GEJ are rare gastric mucosal overgrowths, with an estimated prevalence of less than 2%. They are usually asymptomatic and often found incidentally on EGD done for reflux disease. Depending on the size, they may present with dysphagia or anemia due to obstruction or ulceration, respectively. They are more common in men and show a strong association with gastroesophageal reflux disease and Barrett’s esophagus. Our case is notable for both dysphagia and anemia in the absence of reflux and heartburn. Endoscopic submucosal dissection enabled en bloc resection and full histologic evaluation, making it an effective diagnostic and therapeutic tool for symptomatic or suspicious GEJ lesions.