Could a Benign Liver FNH Affect My Stomach During Endoscopy?

The endoscopy report indicates that one area was pushed or distended?

Hello Dr.
Chen: I recently underwent an upper gastrointestinal endoscopy, and there were no significant issues.
However, the doctor mentioned that a part of my stomach was being pushed by something external, but the stomach itself is fine and suggested that I continue to monitor it.
Upon returning home, I recalled that I have a 10 cm benign focal nodular hyperplasia (FNH) in the left lobe of my liver, which has been under surveillance for ten years.
Based on the anatomical distribution of the organs, do you think it is possible that this FNH is pressing against my stomach? Thank you!

Xiao Li, 40~49 year old female. Ask Date: 2019/01/17

Dr. Chen Qifeng reply Gastroenterology and Hepatology

First, it is essential to establish the presence of external compression.
From an anatomical perspective, it may indeed be related to a benign lesion of the left liver.

Reply Date: 2019/01/17

More Info

The question of whether a benign liver lesion, specifically a focal nodular hyperplasia (FNH), could exert pressure on the stomach during an endoscopy is quite pertinent, especially considering the anatomical relationships between the liver and the gastrointestinal tract.
Focal nodular hyperplasia is a benign liver tumor that is often asymptomatic and typically does not require treatment unless complications arise. In your case, the FNH is located in the left lobe of the liver and measures 10 cm, which is substantial. The liver is situated in the upper right quadrant of the abdomen, while the stomach is located just beneath it, primarily in the left upper quadrant. Given this anatomical arrangement, it is indeed possible for a large FNH to exert pressure on the stomach, particularly if it is significantly enlarged or if there are other factors at play, such as the position of the patient during the endoscopy.

During an endoscopic examination, if the stomach is distended or if the endoscope is maneuvered in a way that brings it into contact with the liver, any mass effect from the liver could potentially be felt. The endoscopist may note that a portion of the stomach appears to be compressed or displaced due to an external structure, which in this case could be the FNH. However, it is essential to confirm that the FNH is indeed the cause of any observed pressure effect.
In clinical practice, the presence of a large FNH is often monitored through imaging studies rather than invasive procedures, as the risk of complications from interventions like biopsy is generally not justified for benign lesions. If the FNH has been stable over the years and has not shown any signs of malignancy, the recommendation to continue monitoring is appropriate.
It is also worth noting that while FNH is benign, any significant mass in the liver can lead to symptoms such as abdominal discomfort or changes in gastrointestinal function due to its size and location. If you are experiencing symptoms such as discomfort, bloating, or changes in appetite, it would be prudent to discuss these with your healthcare provider. They may consider further imaging studies, such as an ultrasound or MRI, to assess the FNH and its relationship with surrounding structures, including the stomach.

In summary, while it is possible for a large FNH to exert pressure on the stomach, leading to observations during an endoscopy, it is crucial to correlate these findings with clinical symptoms and imaging results. If there are any concerns about the FNH or its effects on your gastrointestinal health, a thorough discussion with your healthcare provider is recommended to ensure appropriate management and follow-up.

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