From the Guidelines
Sessile polyps in the stomach are worrisome for gastric cancer, particularly those larger than 15 mm, and should be resected using endoscopic submucosal dissection (ESD) to reduce the risk of recurrence and invasive neoplasia. The management of gastric adenomas, which include sessile polyps, should prioritize their resection due to the significant risk of progression to cancer 1. When evaluating sessile polyps, it's crucial to consider factors such as size, with those larger than 15 mm being at higher risk, and the presence of dysplasia, which increases the malignant potential.
The British Society of Gastroenterology guidelines recommend that all adenomas should be resected when clinically appropriate and safe to do so, with a follow-up gastroscopy performed at 6-12 months after endoscopic resection 1. For hyperplastic polyps, which are another common type of gastric polyp, the guidelines suggest resection for those larger than 1 cm, pedunculated, or symptomatic, with H. pylori eradication considered before endoscopic resection 1.
Key considerations in the management of sessile polyps include:
- Complete removal of the polyp when possible, followed by histological examination to determine the presence of dysplasia or cancer.
- The use of ESD for sessile polyps larger than 15 mm to reduce the risk of recurrence and invasive neoplasia.
- Surveillance gastroscopy at regular intervals, typically 6-12 months after resection, and then annually, depending on the polyp type and the presence of risk factors such as dysplasia or synchronous neoplasia 1.
- Evaluation of the background mucosa for conditions like atrophic gastritis, gastric intestinal metaplasia (GIM), and H. pylori infection, which can increase the risk of gastric cancer 1.
In clinical practice, the approach to sessile polyps should be individualized, taking into account the size, histology, and symptoms of the polyp, as well as the patient's overall risk profile for gastric cancer. The primary goal is to prevent the progression to gastric cancer through early detection and removal of premalignant lesions, emphasizing the importance of regular surveillance and adherence to guidelines for the management of gastric polyps 1.
From the Research
Sessile Polyps and Gastric Cancer
- Sessile polyps in the stomach can be a concern for gastric cancer, although the majority of gastric polyps have a low malignant potential 2.
- Studies have shown that certain types of gastric polyps, such as adenomatous polyps and fundic gland polyps, can give rise to cancer and share some risk factors and mechanisms with gastric cancer 2, 3.
- A study on patients with familial adenomatous polyposis (FAP) found that those with sessile gastric polyps were more likely to have a family history of gastric cancer and certain endoscopic features, such as white mucosal patches in the proximal stomach and antral polyps 3.
- Another study reviewed the clinical, endoscopic, and histopathologic features of various gastric polyps and provided management recommendations, highlighting the importance of considering the type and characteristics of the polyp when assessing the risk of gastric cancer 4.
- A review of gastric epithelial polyps noted that some types of polyps can be considered reactive or nonneoplastic, while others are neoplastic in origin and may have malignant potential, emphasizing the need for careful diagnosis and consideration of the polyp's characteristics 5.
- The presence of Helicobacter pylori in gastric hyperplastic polyps has also been studied, with findings suggesting that H. pylori are commonly present in the polyp tissue when the surrounding mucosa shows H. pylori gastritis 6.