Published online Oct 16, 2017. doi: 10.4253/wjge.v9.i10.529
Peer-review started: April 10, 2017
First decision: May 16, 2017
Revised: May 24, 2017
Accepted: June 30, 2017
Article in press: July 3, 2017
Published online: October 16, 2017
Processing time: 190 Days and 1.5 Hours
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.
Core tip: Although for cap polyposis, conservative treatment should be selected as first-line therapy, the optimal treatment of cap polyposis refractory to conservative treatment has not been established. Endoscopic submucosal dissection may be a treatment option for cases refractory to conservative treatment.