Fujihara et al. Journal of Medical Case Reports 2012, 6:268 http://www.jmedicalcasereports.com/content/6/1/268 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Endoscopic hemostasis with endoscopic mucosal resection and multiple synchronous early gastric cancers: a case report Shintaro Fujihara*, Hirohito Mori, Noriko Nishiyama, Mitsuyoshi Kobayashi, Hideki Kobara and Tsutomu Masaki Abstract Introduction: Endoscopic hemostasis for severe upper gastrointestinal bleeding due to tumors, such as gastrointestinal stromal tumors and malignant lymphoma, is temporarily effective. However, permanent hemostasis is difficult in many cases because of diffuse bleeding. Case presentation: A 60-year-old Japanese woman was admitted to our hospital with hematemesis. Endoscopy revealed multiple gastric polyps and fresh blood in her stomach. One of the gastric polyps, which was associated with oozing bleeding, was found near the anterior wall of the lower gastric body. We initially applied hemostatic forceps and argon plasma coagulation over the tumor surface, but the bleeding persisted. After endoscopic mucosal resection, exposed vessels were seen at the base of the mucosal resection site with oozing bleeding. Coagulation of the bleeding vessels using hemostatic forceps allowed successful completion of the hemostatic procedure. Our patient also had eight synchronous gastric cancer lesions. Histological examination of the resected specimens showed various types of cancer. Conclusion: This is a case report of gastric cancer associated with eight gastric cancer lesions, confirmed by histology, in which hemostasis was achieved through endoscopy. Introduction Endoscopic hemostasis for severe upper gastrointestinal (GI) bleeding due to tumors, such as GI stromal tumors and malignant lymphoma, is temporarily effective [1]. However, permanent hemostasis is difficult in many cases because of diffuse bleeding [2]. We here report a case of endoscopic hemostasis with endoscopic mucosal resection (EMR) as a rescue therapy for bleed- ing of a malignant GI tumor after failed conventional therapy. This patient also had multiple synchronous gastric cancers. Case presentation A 60-year-old Japanese woman was admitted to our hospital with hematemesis. She had no history of GI hemorrhage, peptic ulcer disease, use of nonsteroidal anti-inflammatory drugs, excessive alcohol ingestion, or * Correspondence: joshin@med.kagawa-u.ac.jp Department of Gastroenterology and Neurology, Kagawa University, Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan chronic liver disease. She had no other medical problems and was taking no medications. On presentation, her abdomen was soft, nontender, and nondistended with normal bowel sounds. Her hemoglobin level was 8.5g/dL. Contrast-enhanced com- puted tomography (CT) revealed multiple lesions in her stomach. Hematologic tests revealed a total peripheral 3 white cell count of 14,400/mm . Biochemical tests yielded elevated serum blood nitrogen (30.7mg/dL), decreased total protein (3.8g/dL), and decreased serum albumin (2.0mg/dL). Endoscopy revealed multiple gastric polyps and fresh blood in her stomach. One of the gastric polyps, which was associated with oozing bleeding, was found near the anterior wall of the lower gastric body. Hemostatic for- ceps (Coagrasper, FD-410LR; Olympus, Tokyo, Japan) were initially applied over the tumor surface, but because the bleeding persisted, argon plasma coagulation (APC) was performed around the bleeding site. Mucosal oozing continued after failed APC and the application of the hemostatic forceps (Figure 1). © 2012 Fujihara et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.