At repeat endoscopy her stomach looked the same: multiple linear strings of polyps, as seen in the picture.
These chains of polyps follow the lines of the ruggae of the stomach. Unlike typical adenomas, these were located in the proximal 2/3 of the stomach. The antrum is clear of polyps, and H. pylori negative, again.
We did snare polypectomies, removing 4 of the larger polyps. They were all about 1 or 1.3 cm diameter. It was difficult to retrieve the polyps, since the stomach peristalsis tends to sweep them distally. Electrocautery snare technique was employed, without other difficulty.
The pathology is benign adenomas.
Option 1: It is possible, but difficult to continue with endoscopic polypectomies. It will take a few hours to remove all of her polyps (possibly 100). And, I cannot be sure of retrieving all of these, so there is a risk of losing pathological information. Because of the risks of aspiration, and length of the procedure, an endotracheal tube would be required for such an effort. Could I just snare and drop these polyps in the stomach, allowing their digestion, losing specimens, while speeding the procedure?
Option 2: Subtotal, or near total gastrectomy, which seems extreme for benign disease. Should I anastamose esophagus to antrum, or a Roux limb?
Option 3: Surveillance gastroscopy every few months, removing any polyps that look larger, or atypical.
My other concern is for the mid and lower gut. Are studies of the jejunum and ileum required? A colonoscopy is planned.