Clinical presentation

An 87-year-old man presented for endoscopy for investigation of anorexia, abdominal bloating and fullness for the previous 2 months. He had had a subtotal gastrectomy with a Billroth II anastomosis 40 years previously for a gastric ulcer with bleeding. Upper endoscopy revealed a 20 mm diameter, broad-based polypoid lesion with a smooth surface at the greater curvature of the middle body of the stomach (figure 1). Biopsies from the surface mucosa showed mild chronic inflammation and mild foveolar hyperplasia and were negative for Helicobacter pylori infection. Abdominal CT revealed a 2×2 cm protruding smooth nodular lesion in an area in keeping with a submucosal lesion such as a gastrointestinal stromal tumour …