What to do About Gastric Polyps
When clinicians detect a gastric polyp during endoscopy, they are faced with many questions: does the polyp need to be excised, or can a biopsy sample be collected and analyzed? Which polyps should be biopsied? Should patients then be followed, and how? In the November issue of Clinical Gastroenterology and Hepatology, Yasser H. Shaib et al. attempt to provide some practical answers to these questions.
A gastric polyp is an abnormal growth from the gastric mucosal membrane. Detection of stomach polyps prompts concerns about histology, cause, progression, and possible treatment.
The overall incidence of gastric polyps has increased in North America, and there has been a shift in the proportions of types detected—clinically inconsequential fundic gland polyps have become the most prevalent, whereas those associated Helicobacter pylori–induced gastritis (hyperplastic and adenomatous polyps) have become less common. In contrast, in East Asia, Latin America, and possibly Africa, where H. pylori infection and chronic gastritis are still common, and larger proportions of gastric polyps are either hyperplastic or neoplastic.
In their Perspective article, Shaib et al. discuss the features, diagnostic criteria, and management strategies for different types of gastric polyps.
For example, fundic gland polyps (see below figure), which are usually multiple, small (less than 1 cm), and smooth, should be biopsied upon detection, but large polyps (>1 cm in diameter) should be removed.
Fundic gland polyps are often detected in patients who have taken proton pump inhibitors for prolonged time periods. Shaib et al. propose that when more than 20 polyps are present, or their size is larger than 1 cm, patients should be asked to stop taking these drugs, to see if the polyps regress.
The authors also provide advice for diagnosis and management of hyperplastic gastric polyps, gastric adenomas, gastrointestinal stromal tumors, inflammatory fibroid polyps, gastric neuroendocrine tumors.
Shaib et al. remind us that no polyp is an island unto itself—after polyps are removed or sampled, the non-affected gastric mucosa should be inspected and biopsy samples should be collected and examined.
Few data are available on short- or long-term outcomes of gastric polyps, so no evidence-based guidelines exist. Shaib et al. suggest that patients undergo surveillance endoscopy within 1 year of detection of non-fundic gland polyps, to check for recurrence. Patients with high-grade dysplasia or early-stage cancer should be followed for at least 2–3 years, at short intervals (6 months). Gastric carcinoids managed endoscopically (usually type 1) should be followed via endoscopy, every 1–2 years.