# Improvement in Protein-Losing Gastroenteropathy Due to Gastric Polyposis by Laparoscopic Total Gastrectomy: A Case Report

## TL;DR

A man with a rare genetic condition had successful treatment for severe stomach and intestinal issues through a minimally invasive stomach removal surgery.

## Contribution

Laparoscopic total gastrectomy is shown to effectively treat protein-losing gastroenteropathy in gastric juvenile polyposis syndrome.

## Key findings

- The patient's symptoms resolved after laparoscopic total gastrectomy.
- The patient remained healthy for 4 years post-surgery without symptom recurrence.
- The procedure eliminated the risk of malignant transformation of gastric polyps.

## Abstract

Juvenile polyposis syndrome (JPS) is a rare disease characterized by multiple hamartomatous polyps in the gastrointestinal tract that may cause protein-losing gastroenteropathy. In such cases, symptoms such as hypoalbuminemia and anemia are often difficult to manage. Although clinical guidelines provide recommendations for diagnosis and management, standardized treatment strategies remain to be fully established.

A 40-year-old man underwent laparoscopic total gastrectomy for protein-losing gastroenteropathy secondary to gastric polyposis. He had a history of colorectal polyposis associated with an SMAD4 mutation and had previously undergone subtotal colectomy. The patient developed worsening anemia and hypoproteinemia. Upper gastrointestinal endoscopy revealed an increase in both the size and number of gastric polyps. Protein-losing gastroenteropathy was diagnosed using technetium-99m human serum albumin scintigraphy. Laparoscopic total gastrectomy with Roux-en-Y reconstruction was performed to control hypoproteinemia and eliminate the risk of malignant transformation of the polyps. Postoperatively, the symptoms resolved, and oral intake improved. He remained in good health and has continued a normal daily life without symptom recurrence for 4 years postoperatively.

We present a case of JPS with an SMAD4 mutation causing protein-losing gastroenteropathy and refractory anemia, successfully treated with laparoscopic total gastrectomy. The patient’s sustained nutritional status suggests that total gastrectomy may be an effective treatment option for gastric JPS with protein-losing gastroenteropathy.