From the Guidelines
The recommended management for a patient with a hyperplastic gastric polyp is to resect polyps larger than 1 cm, those with pedunculated morphology, or symptomatic polyps, and to consider H. pylori eradication before re-evaluation for endoscopic therapy. This approach is based on the most recent guidelines from the British Society of Gastroenterology, which suggest that hyperplastic polyps >1 cm, pedunculated morphology, and those causing symptoms should be resected 1. Additionally, the guidelines recommend that if H. pylori is present, it should be eradicated before re-evaluation for endoscopic therapy, as many polyps will regress after eradication 1.
The management of hyperplastic gastric polyps should also involve careful evaluation of the background mucosa for synchronous neoplasia, degree and extent of gastric atrophy (GA), and H. pylori infection 1. The diagnosis of hyperplastic polyps and the absence of dysplasia should be confirmed by histology, and the remainder of the stomach should be carefully evaluated for synchronous neoplasia and other potential risks 1.
Some key points to consider in the management of hyperplastic gastric polyps include:
- Resect polyps larger than 1 cm, those with pedunculated morphology, or symptomatic polyps 1
- Consider H. pylori eradication before re-evaluation for endoscopic therapy 1
- Carefully evaluate the background mucosa for synchronous neoplasia, degree and extent of GA, and H. pylori infection 1
- Confirm the diagnosis of hyperplastic polyps and the absence of dysplasia by histology 1
- Consider the potential risks of malignant transformation, especially in larger polyps or those with dysplasia 1
Overall, the management of hyperplastic gastric polyps should be individualized based on the size, morphology, and symptoms of the polyp, as well as the presence of underlying risk factors such as H. pylori infection or GA. By following these guidelines and considering the latest evidence, clinicians can provide effective and personalized care for patients with hyperplastic gastric polyps.
From the Research
Hyperplastic Gastric Polyp Management
The recommended management for a patient with a hyperplastic gastric polyp depends on various factors, including the size and location of the polyp, as well as the presence of symptoms.
- For symptomatic polyps, removal is recommended for a reliable histological diagnosis, resolution of symptoms, and to prevent potential malignant transformation 2.
- Endoscopic mucosal resection is a suitable method for removing hyperplastic gastric polyps, as it provides tissue for histopathologic examination and achieves symptomatic treatment 2, 3.
- Snare polypectomy is a effective method for removing large polyps, and can resolve symptoms such as dyspepsia and intermittent pyloric obstruction 4.
Factors Influencing Management
Several factors can influence the management of hyperplastic gastric polyps, including:
- Size: Polyps larger than 5mm are recommended to be removed 5.
- Location: Polyps located in the antrum or corpus may require different management approaches 5.
- Symptoms: Symptomatic polyps, such as those causing dyspepsia, abdominal pain, or upper gastrointestinal bleeding, require removal 2, 3, 4.
Special Considerations
In some cases, hyperplastic gastric polyps may be associated with proton pump inhibitor use, and discontinuation of treatment may lead to disappearance of the polyps 6.
- However, the natural history and clinical significance of these polyps are not yet fully understood, and further studies are needed to determine the best course of management.