A 47 yrs male patient was considered for OGD scopy sos intervention in view of recent h/o malena/ haematochezia. Patient has h/o similar episode with detected ulcer on endoscopy done elsewhere a few years ago. Patient also complains of wt loss.

  • OGD scopy revealed irregular nodular mucosal changes with abnormal appearing anterior wall of stomach body with a large ulcer with actively bleeding artery in the base.
  • Proximal duodenum appeared normal
  • The actively bleeding ulcer was treated with heater probe coagulation.
  • Complete haemostasis was ensured. To add we injected diluted saline adrenaline around the ulcer to create tamponade.
  • Biopsies were taken from the ulcer edges for histology.
  • Previously treated ulcer in the stomach appeared healing and medical treatment seems to be reducing the gastric inflammation.
  • Diagnosed bleeding gastric ulcer that was treated few days back and therefore this relook endoscopy sos EUS.
  • Minimal hypoechoic thickening (9.0mm) was noted in the ulcer site, but it appeared more like an inflammatory rather than neoplastic.
  • One hypoechioc 1.0 cm node was seen in the celiac axis region.
  • No obvious mass lesion seen in the stomach otherwise.
  • Final HPE & IHC of the biopsy showed MALT Lymphoma secondary to H.Pylori
  • Patient was then treated with medical treatment for H.pylori eradication

A large ulcer with actively bleeding artery in the base

The actively bleeding ulcer was treated with heater probe coagulation

 

 

 

 

 

 

 

 

Complete haemostasis was ensured. To add we injected diluted saline adrenaline around the ulcer to create tamponade.

Biopsies were taken from the ulcer edges for histology.

 

 

 

 

 

 

 

 

 

Proximal duodenum appeared normal

Previously treated ulcer in the stomach appeared healing on NBI view

 

 

 

 

 

 

 

 

Minimal hypoechoic thickening (9.0mm) was noted in the ulcer site

One hypoechioc 1.0 cm node was seen in the celiac axis region

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