What is the management approach for patients with gastric polyps?

From the Guidelines

The management of gastric polyps should be guided by their histological type, size, and associated risk factors, with adenomatous polyps requiring complete endoscopic resection due to their malignant potential, as recommended by the British Society of Gastroenterology guidelines 1. The approach to managing gastric polyps involves several key steps, including:

• Documenting the number, location, and size of the polyps, as well as taking photographic documentation 1
• Biopsying gastric polyps other than fundic gland polyps for histopathological assessment 1
• Assessing the background mucosa for gastric atrophy, gastric intestinal metaplasia, H. pylori, and synchronous neoplasia if adenomas or hyperplastic polyps are present 1
• Resecting all adenomas when clinically appropriate and safe to do so, with follow-up gastroscopy at 12 months and ongoing surveillance gastroscopy annually thereafter 1
• Considering resection of hyperplastic polyps >1 cm, pedunculated morphology, or those causing symptoms, and eradicating H. pylori if present 1 Key considerations in the management of gastric polyps include:
• The malignant potential of adenomatous polyps, which necessitates complete endoscopic resection regardless of size 1
• The importance of documenting and characterizing gastric polyps to guide management decisions 1
• The role of H. pylori eradication in the management of hyperplastic polyps 1
• The need for ongoing surveillance gastroscopy in patients with a history of adenomas or other high-risk polyps 1

From the Research

Management Approach for Gastric Polyps

The management approach for patients with gastric polyps involves several steps, including:

• Diagnosis through endoscopy and biopsy to determine the type of polyp and the presence of dysplasia 2, 3, 4
• Classification of polyps into different types, such as hyperplastic polyps, fundic gland polyps, and adenomatous polyps, each with its own malignant potential 2, 3, 4
• Assessment of the size and location of the polyps, as well as the presence of any symptoms 2, 3

Treatment Options

Treatment options for gastric polyps depend on the type and size of the polyp, as well as the presence of dysplasia or symptoms. These options include:

• Endoscopic snare polypectomy for polyps that are ≤2 cm in size and have no dysplasia 2, 3
• Endoscopic mucosal resection for polyps that are ≥2 cm in size or have dysplasia 3
• Surveillance for polyps that are small and have no dysplasia, with regular follow-up endoscopies to monitor for any changes 4, 5

Special Considerations

There are several special considerations in the management of gastric polyps, including:

• The use of proton pump inhibitors, which may be associated with the development of fundic gland-type gastric polyps 6
• The presence of genetic syndromes, such as familial adenomatous polyposis, which may increase the risk of developing gastric polyps 4
• The importance of sampling the normal-appearing gastric mucosa to stage atrophic changes and rule out endoscopically non-visible dysplasia 4