Cap polyposis refractory to Helicobacter pylori eradication treated with endoscopic submucosal dissection

Abstract

Cap polyposis is a rare intestinal disorder. Characteristic endoscopic findings are multiple inflammatory polypoid lesions covered by caps of fibrous purulent exudate. Although a specific treatment has not been established, some studies have suggested that eradication therapy for Helicobacter pylori (H. pylori) is effective. We report a case of a 20-year-old man with cap polyposis presenting with hematochezia. Colonoscopy showed the erythematous polyps with white caps from the sigmoid colon to rectum. Histopathological findings revealed elongated, tortuous, branched crypts lined by hyperplastic epithelium with a mild degree of fibromusculosis in the lamina propria. Although H. pylori eradication was instituted, there was no improvement over six months. We then performed en bloc excision of the polyps by endoscopic submucosal dissection (ESD), which resulted in complete resolution of symptoms. ESD may be a treatment option for cap polyposis refractory to conservative treatments. We review the literature concerning treatment for cap polyposis and clinical outcomes.

Verrucous gastritis-like lesion in intramucosal Helicobacter pylori-uninfected signet ring cell carcinoma with poorly differentiated adenocarcinoma

“…The lesion was located in the gastric antrum, and fibromuscular obliteration of the muscularis propria caused an elevated lesion. Fibromuscular obliteration of the muscularis propria is reported in conditions such as rectal mucosal prolapse syndrome and occurs when smooth muscle bundles extend from the muscularis mucosa into the lamina propria [ 21 ]. In our case, immunohistochemical staining indicated fibromuscular obliteration around the pyloric glands in the background mucosa surrounding the lesion.…”

Cap Polyposis: An Elusive Diagnosis in a Pediatric Patient Successfully Managed With Endoscopic Treatment

“… 3 , 10 , 16 Because there have been no reports of malignant transformation in cap polyposis, surgical resection may be unnecessary. As a less invasive alternative, Murata et al 17 suggested endoscopic management with ESD en bloc excision. In the present case, the extent of submucosal fibrosis and the circumferential nature and localization of the lesions would have made ESD very challenging.…”

Clinical characteristics and treatments of cap polyposis: a single center case series

“…Since it is less invasive, EMR should be recommended for most patients with rectosigmoid involvement, especially for those with few polyps. Endoscopic submucosal dissection (ESD) was also reported to be successful in an intractable cap polyposis with rectosigmoid involvement [ 5 ]. ESD might be a treatment option for cases that are refractory to conservative treatments.…”