Source
Service
d' hépato-gastroentérolgie, CHU Bichat Claude Bernard, Paris.
thierry.vallot@bch.ap-hop-paris.fr
Abstract
Gastric
polyps exist in a wide variety of types, most often benign. Endoscopic
discovery of gastric polyps necessitates biopsies - not only of the lesion but
also of the antral and fundic mucosa to determine the therapeutic strategy and
subsequent surveillance. Fundic gland polyps are the most frequent type; they
are asymptomatic with no malignant potential. They require neither treatment
nor surveillance. Hyperplastic polyps, adenomas and tumors must be totally
resected. Biopsies alone are insufficient to assess the extent of malignancy of
adenomas and of hyperplastic polyps more than 5 mm in diameter. These polyps
are associated with an elevated frequency of precancerous alterations of the
gastric mucosa and consequently by an elevated risk of synchronous or
metachronous cancer. Eradication of Helicobacter pylorus may reduce the risk of
metachronous gastric cancer and recurrence after resection. Carcinoid tumors of
the fundus most often occur in patients with hypergastrinemia during atrophic
gastritis of autoimmune origin; they are not serious. The advantages and
procedures for endoscopic surveillance of patients with a precancerous
condition of the gastric mucosa have not yet been clearly established in
populations with a low incidence of cancer.
Giant gastric hyperplastic polyp: not always a benign lesion, Dang S, McElreath DP, Kumar S, Kakati B, Atiq M, Morton WJ, Aduli F. J Ark Med Soc. 2010 Oct;107(5):89-92.
Abstract
Giant gastric hyperplastic polyps constitute of around 76% of all gastric polyps found. They are often found incidentally on upper GI endoscopy. They often present with occult GI bleeding causing iron deficiency anemia or partial gastric outlet obstruction. Although mostly benign, they do have potential for malignant transformation and hence must be excised endoscopically or surgically, whichever may be feasible
Clinical consequences of the endoscopic diagnosis of gastric polyps. Stolte M., Endoscopy. 1995 Jan;27(1):32-7; discussion 59-60.
Source
Institute of Pathology, Klinikum Bayreuth, Germany.Abstract
The procedure following endoscopic detection of a gastric polyp depends on the findings on histological examination of the lesion, for which forceps biopsy material usually suffices. If Elster's polyps are present, the recommendation is merely a search for epithelial tumors in the colorectum, which occur statistically more frequently in these patients. In the case of hyperplastic polyps, the recommended procedure is endoscopic polypectomy, typing of gastritis and regular follow-up examinations. Carcinoid tumors, which usually arise in type A gastritis, require only follow-up, while sporadic carcinoid tumors should be treated surgically. Irrespective of the type and grade of dysplasia, adenomas of the gastric mucosa should always be removed in toto. Polypoid type I or type IIa early carcinomas of the stomach initially only need to be removed endoscopically. If histological examination then reveals well or moderately differentiated adenocarcinoma limited to the mucosa, surgery is not necessary, but regular follow-up is essential.
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