ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual)

Yang_ASGE Post Grad UGI Lesions

Pdf Summary

The document discusses two cases of commonly encountered upper GI lesions: gastric neuroendocrine tumors (G-NETs) and gastric hyperplastic polyps (GHPs). <br /><br />Case #1 involves a 65-year-old woman with anemia. The pathology findings reveal well-differentiated neuroendocrine tumor involvement in the polypoid gastric mucosa. G-NETs originate from histamine-secreting, enterochromaffin-like cells and are divided into three types: Type I, Type II, and Type III. Type I is associated with achlorhydria and has a good prognosis. Type II is associated with Zollinger-Ellison syndrome and MEN-1 syndrome. Type III is poorly differentiated and has a poor prognosis. The evaluation of G-NETs includes endoscopy with biopsies, lab tests, histology analysis, and imaging. Management depends on the size of the lesions, with surveillance recommended for small lesions (<1 cm) and more aggressive treatment for larger lesions. <br /><br />Case #2 involves a 58-year-old man with NAFLD cirrhosis and persistent anemia. Fecal occult blood tests are positive. The patient has gastric hyperplastic polyps (GHPs), which are characterized by excessive proliferation of foveolar cells. Risk factors for neoplastic transformation of GHPs include size (≥25 mm) and the presence of adjacent gastric intestinal metaplasia. The document discusses the risk of recurrence after endoscopic resection, which is influenced by factors such as En-Bloc and R0 resection and portal hypertension. The decision to resect GHPs should consider the risk-benefit ratio and the presence of associated mucosal pathology. Surveillance is recommended for GHPs that do not meet resection criteria. <br /><br />In summary, the management of G-NETs depends on the subtype, with surveillance and different treatment approaches based on the size and characteristics of the lesions. GHPs should be resected if symptomatic or ≥25 mm, while the decision for resection of smaller lesions should consider the high recurrence rate. Evaluation of the entire stomach for other pathology is important in both G-NETs and GHPs.

Keywords

upper GI lesions

gastric neuroendocrine tumors

G-NETs

gastric hyperplastic polyps

GHPs

well-differentiated neuroendocrine tumor

achlorhydria

Zollinger-Ellison syndrome

MEN-1 syndrome

NAFLD cirrhosis