What is the appropriate follow-up testing for a pedunculated gastric adenoma?

From the Guidelines

The appropriate follow-up testing for a pedunculated gastric adenoma should include a follow-up gastroscopy at 6–12 months after endoscopic resection, with subsequent surveillance gastroscopy at yearly intervals. This recommendation is based on the British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma, which emphasizes the importance of regular follow-up to monitor for recurrence and progression to cancer 1.

Key Considerations

• The guidelines recommend endoscopic resection as the preferred mode of treatment for gastric adenomas, with an en bloc excision using endoscopic submucosal dissection (ESD) advised for sessile polyps >15 mm due to the high risk of invasive neoplasia 1.
• A careful evaluation of the stomach should be carried out to identify synchronous neoplasia, which occurs in approximately 30% of cases 1.
• The degree of dysplasia and diagnosis of adenoma should be histologically confirmed before treatment is undertaken, and patients with adenomas should continue to have surveillance gastroscopy at yearly intervals, depending on the number of polyps, their size, and the highest grade of dysplasia 1.

Follow-up Schedule

• A follow-up gastroscopy should be performed at 6–12 months after endoscopic resection of adenomas, with subsequent surveillance gastroscopy at yearly intervals 1.
• The follow-up schedule may need to be adjusted based on individual patient factors, such as the size and number of polyps, and the grade of dysplasia.
• It is essential to monitor for recurrence and progression to cancer, as gastric adenomas are premalignant lesions with potential for malignant transformation.

From the Research

Follow-up Testing for Pedunculated Gastric Adenoma

• The management of gastric adenomas is crucial for preventing the development of gastric cancers and detecting gastric cancers at earlier stages 2.
• The Vienna classification divides gastric adenomas into two categories: high-grade dysplasia and low-grade dysplasia, with endoscopic resection generally performed for adenomas with high-grade dysplasia 2.
• For low-grade dysplasia, two treatment strategies have been suggested: 'wait and see' or endoscopic treatment, such as endoscopic mucosal resection, endoscopic submucosal dissection, or argon plasma coagulation 2, 3.
• Regular endoscopic follow-up is necessary to detect any residual or recurrent lesions, especially after argon plasma coagulation treatment, due to the relatively high rate of local recurrence 3.
• The risk of developing carcinoma from gastric adenoma is high, with a 5-year rate of carcinoma development of 34.0%, and risk factors include lesion size ≥15 mm and morphological depression 4.
• Metachronous gastric cancer can occur in 1.5% of patients annually, with the only risk factor being primary adenoma progressing to carcinoma during follow-up 4.
• Imaging modalities such as multidetector computed tomography (MDCT), endoscopic ultrasonography, magnetic resonance imaging (MRI), and positron emission tomography (PET) can be used for detecting, staging, and assessing treatment response for gastric carcinoma 5.

Recommended Follow-up

• Regular endoscopic follow-up is recommended to detect any changes in the primary adenoma or the occurrence of metachronous carcinoma 4.
• The frequency and duration of follow-up should be determined based on the individual patient's risk factors and the characteristics of the adenoma 4.
• Imaging modalities such as MDCT, endoscopic ultrasonography, MRI, and PET can be used to assess treatment response and detect recurrence after surgical resection 5.