EGD Masterclass: EoE, Strictures, and Pre-malignant Gastric Conditions (On-demand) | January 2023-Madhav Desai

Madhav Desai_Gastric polyps and cancer

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This document provides an overview of gastric polyps, including their types, malignant potential, endoscopic evaluation, and management. Gastric polyps can be categorized into epithelial and subepithelial polyps. Epithelial polyps include fundic, hyperplastic, adenoma/GC, hamartomatous, and GNET polyps, while subepithelial polyps include GIST, GNET, lipoma, and leiomyoma. <br /><br />Fundic gland polyps are the most common type of gastric polyps and are usually small, multiple, and located in the corpus or body of the stomach. They have low malignant potential unless they are larger than 1 cm or associated with familial adenomatous polyposis (FAP). Hyperplastic polyps are usually single or few and located in the antrum. They can regress with H. pylori eradication but have an increased risk of synchronous cancer. Adenomatous polyps are single, small, and located in the antrum or incisura. They have a higher prevalence in the Western world and are associated with gastric atrophy and gastric intestinal metaplasia (GIM). <br /><br />The management of gastric polyps depends on their size and characteristics. Fundic gland polyps larger than 1 cm, with atypical features or antral location should be resected. Hyperplastic polyps larger than 1 cm, pedunculated, or symptomatic should also be resected. All adenomatous polyps, regardless of size, should be resected. Hamartomatous polyps, such as juvenile polyps and polyps associated with Peutz-Jeghers syndrome and Cowden's disease, may require further evaluation and surveillance. <br /><br />During endoscopic evaluation, it is important to adequately insufflate the stomach and clear any bubbles or debris. Documentation should include the number, location, and size of the largest polyp, as well as photographic documentation. Biopsy should be performed on the polyp and background mucosa, and H. pylori should be eradicated in cases of hyperplastic and adenomatous polyps. The rest of the stomach should also be examined for mucosal abnormalities and biopsied if necessary.<br /><br />In summary, gastric polyps are common and can have varying malignant potential. High-quality endoscopy, thorough evaluation, and appropriate management are crucial in the management of gastric polyps.

Keywords

gastric polyps

types

malignant potential

endoscopic evaluation

management

epithelial polyps

subepithelial polyps

fundic gland polyps

hyperplastic polyps

adenomatous polyps