Gastric White Mucosal Patch in Familial Adenomatous Polyposis

A 64-year-old woman with familial adenomatous polyposis (FAP) underwent surveillance upper endoscopy whereupon an 80-mm flat white mucosal patch (WMP) was noted in the proximal gastric body (a). High-risk features on narrow band imaging based on surveillance for pathology associated with cancer on endoscopy criteria to identify high-risk gastric polyps in FAP criteria were noted (lighter mucosa and irregular and bumpy appearance with an open pit pattern). Biopsies of the WMP revealed gastric adenoma with low-grade dysplasia. The patient was not on a proton pump inhibitor. There has been an increased incidence of gastric cancer in patients with FAP. Because of the high-risk nature of this lesion, we resected the WMP using endoscopic submucosal dissection to ensure complete removal (b and c). The WMP was approached in retroflexion, and a ProdiGI traction wire (ERD-TW35; Medtronic, Dublin, Ireland) was used for traction. Postresection histology showed the foveolar-type gastric adenoma with low-grade dysplasia. Helicobacter pylori was negative. Because of the absence of high-grade dysplasia or cancer, surgery was not indicated. The patient did well on follow-up with no adverse events. (Informed consent was obtained from the patient to publish these images.)