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