Editing Gastric polyps


== Epidemiology ==

* Seen in about 5% of     gastroscopies

== '''Pathophysiology''' ==

=== '''Adenomatous''' ===

** Adenoma-carcinoma sequence -      risk for malignancy
*** Frequently have mucosal       atypia at least
*** Have been shown to progress       from dysplasia to carcinoma in situ
** Typically solitary
** Risk of malignancy >30%      and increases with increasing size of the polyp
** Endoscopic removal is      sufficient if the polyp is completely removed and there are no foci of      invasive cancer seen
** Indications for surgical      excision:
*** >2cm
*** Sessile
*** Proven focus of invasive       carcinoma

=== '''Fundic gland     polyps''' ===

** Benign lesions resulting      from glandular hyperplasia and decreased luminal flow
** Strongly associated with PPI      use (occur in a third of patients by one year)
** Dysplasia only described in      individual case reports
** Do not require excision,      regular surveillance, or cessation of therapy

=== '''Hyperplastic     polyps''' ===

** Associated with H. pylori      and chronic gastritis
** Malignancy rate <2%

=== '''Peutz-Jeghers     syndrome''' ===

** Higher risk for polyps
** Those polyps have a 2-3%      malignancy rate

== '''Risk factors''' ==

* PPI
* Previous polyps
* Genetic syndromes
* Chronic gastritis/H. pylori
* Others

== '''Presentation''' ==

* Usually asymptomatic, found     incidentally

== '''Management''' ==

* For all patients with polyps
** Biopsy normal mucosa for H.      pylori and underlying dysplasia
* Isolated polyp >1cm
** Complete polypectomy
* Multiple polyps
** Remove the largest      completely and biopsy the rest

[[Category:UGIS]]