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

Madhav Desai_Gastric polyps and cancer

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This document discusses various aspects of gastric polyps and their management. Gastric polyps are classified into different types, including epithelial polyps (such as fundic, hyperplastic, adenoma/gastric cancer, hamartomatous, and gastrointestinal neuroendocrine tumors) and subepithelial polyps (such as GIST, lipoma, leiomyoma). <br /><br />Fundic gland polyps are the most common type, often small and multiple, located in the corpus or body of the stomach. They have a low malignant potential unless they are larger than 1 cm or associated with familial adenomatous polyposis (FAP). Fundic gland polyps associated with long-term use of proton pump inhibitors (PPIs) should be resected, and reassessment of the need for long-term PPI use is recommended. <br /><br />Hyperplastic polyps are usually single or few, located in the antrum of the stomach, and are associated with conditions like H. pylori gastritis, gastric atrophy, and gastric intestinal metaplasia (GIM). They often regress with H. pylori eradication but may have an increased risk of synchronous cancer, dysplasia, and malignant transformation when larger than 1 cm or in postgastrectomy patients.<br /><br />Adenomatous polyps, although less common, have a higher risk of synchronous gastric adenocarcinoma, especially when larger than 2 cm. All adenomas, regardless of size, should be resected when safe to do so, and a detailed evaluation for synchronous lesions is recommended.<br /><br />Other types of polyps discussed include hamartomatous polyps (such as juvenile polyps) and polyps associated with specific syndromes like Peutz-Jeghers syndrome and Cowden's disease.<br /><br />The document emphasizes the importance of high-quality endoscopic evaluation and biopsy of both the polyp and the background gastric mucosa. In addition, eradication of H. pylori infection is recommended for both hyperplastic and adenomatous polyps. Complete polypectomy is advised for certain types and sizes of polyps.<br /><br />Overall, the management of gastric polyps should involve a thorough evaluation of the polyp characteristics, histology, and associated factors in order to guide appropriate treatment and surveillance.

Keywords

gastric polyps

management

epithelial polyps

subepithelial polyps

fundic gland polyps

proton pump inhibitors

hyperplastic polyps

H. pylori eradication

adenomatous polyps

syndromes