From the Research
Approximately 87% of patients with familial adenomatous polyposis (FAP) have gastric polyps, but only a small percentage of these polyps are associated with gastric cancer. The relationship between gastric polyps and cancer depends significantly on the polyp type, with adenomatous polyps carrying the highest malignant potential 1. Patients with FAP have a higher risk of developing gastric cancer, especially in the proximal stomach, where a carpeting of fundic gland polyposis can hamper visualization of gastric cancer and its precursor lesions during endoscopic surveillance 1. Some key points to consider include:
- The prevalence of gastric polyposis is high in FAP patients, with 87% of patients having gastric polyps at any time during surveillance 2
- The majority of gastric polyps in FAP patients are fundic gland polyps, which have a lower malignant potential compared to adenomatous polyps 2
- The presence of high-grade dysplasia, polyps ≥2 cm, and certain types of polyps such as pyloric gland adenomas are associated with an increased risk of gastric cancer in FAP patients 2, 3
- Endoscopic features such as a carpeting of gastric polyps, solitary polyps >20 mm, and a polypoid mound of polyps are associated with an increased risk of gastric cancer in FAP patients 3 The management of gastric polyps in FAP patients should include regular upper endoscopic surveillance, with a focus on detecting high-risk polyps and precursor lesions, and consideration of prophylactic gastrectomy in patients with high-risk lesions or a strong family history of gastric cancer 1.