What is the management for a squamous papilloma in the stomach without dysplastic changes?

Management of Squamous Papilloma in the Stomach Without Dysplastic Changes

Complete endoscopic resection is recommended for gastric squamous papilloma without dysplastic changes to obtain a definitive diagnosis and treatment. 1

Diagnostic Approach

When a squamous papilloma is identified in the stomach:

1. Confirm histological diagnosis: Ensure the diagnosis is confirmed by a GI pathologist to rule out dysplasia or other concerning features 2

2. Evaluate the entire stomach: Carefully examine the remainder of the stomach for:

   • Synchronous neoplastic lesions
   • Evidence of gastric atrophy
   • Intestinal metaplasia
   • H. pylori infection 2

Management Algorithm

For Gastric Squamous Papilloma:

1. Complete endoscopic resection is recommended regardless of size to:

   • Confirm definitive diagnosis
   • Eliminate any potential risk of progression
   • Remove the lesion entirely 1

2. Endoscopic mucosal resection (EMR) is the preferred technique for removal, as demonstrated in case reports of gastric squamous papillomas 1

3. Testing for H. pylori should be performed, as chronic mucosal irritation may be associated with papilloma development 2, 3

   • If positive, eradication therapy should be administered

Factors Influencing Management:

• Size considerations:

  • Similar to hyperplastic polyps, those >1 cm should be prioritized for complete resection 2
  • Pedunculated morphology increases the importance of resection 2

• Location considerations:

  • Lesions near the cardia/esophagogastric junction require careful evaluation to determine origin (gastric vs. esophageal) 1

Post-Resection Surveillance

After complete endoscopic resection of a gastric squamous papilloma without dysplasia:

• Follow-up endoscopy at 6-12 months to confirm complete removal and absence of recurrence 4

• If no recurrence and no other gastric pathology: Return to routine surveillance intervals based on other risk factors 2

• If incomplete resection or multiple lesions: Consider repeat endoscopy at 6 months 4

Important Considerations

• Unlike esophageal squamous papillomas which are more common, gastric squamous papillomas are extremely rare and their natural history is not well documented 1

• While generally considered benign, the prognostic significance of gastric squamous papillomas is not well established, which supports the recommendation for complete removal when possible 1

• Endoscopic resection provides both diagnostic certainty and therapeutic benefit in a single procedure 1

• The differential diagnosis should include other gastric polyps such as hyperplastic polyps, adenomas, and fundic gland polyps, which have different management approaches 2

• Documentation of size, location, and endoscopic appearance is essential for appropriate management and follow-up 5