Resection of a gastric fibroid inflammatory polyp by means of endoscopic submucosal dissection: how deep is deep enough?

Infl ammatory fi broid polyps (FIP) are rare mesenchymal tumors associated with mutations of the platelet-derived growth factor-α. Th ey derive from the submucosal layer and are mainly composed of loose connective tissue, vessels and an eosinophilic infl ammatory component. Th ey are found throughout the gastrointestinal tract, but most commonly in the gastric antrum and ileum. Macroscopically, they present as large polypoid lesions of 3-20 cm in size that maybe pedunculated and ulcerated. Case series and case reports have demonstrated the effi cacy of standard endoscopic techniques with snares and most recently with endoscopic submucosal dissection (ESD) in 5 cases [1,2]. We would like to share our experience in an asymptomatic 60-year-old woman who underwent ESD resection of a 4x3 cm pedunculated FIP located at the gastric antrum (Fig. 1, 2). Th e procedure was uneventful and macroscopically the lesion seemed to be completely resected. Surprisingly, the histology report showed positive deep margins. Due to the benign course of these lesions no additional surgery has been suggested and at one year of follow up there are no signs of endoscopic or histologic recurrence. Th is case illustrates that FIP may expand deep into the submucosal layer beyond the reach of invasive techniques such as ESD. Although the risk of recurrence is minimum, positive deep margins should prompt endoscopists for postoperative follow up since there is at least one report of tumor recurrence aft er endoscopic resection that was detected at 1 year of follow up [3].