What are fundic gland polyps (FGPs)?

From the Guidelines

Fundic gland polyps are benign growths that do not require specific treatment, and patients can be reassured that they have extremely low malignant potential. The management of fundic gland polyps (FGPs) is primarily focused on documentation and possibly biopsy of representative polyps to confirm the diagnosis, as stated in the guidelines by the British Society of Gastroenterology 1. Key points to consider in the management of FGPs include:

• Documentation of the number, location, morphology, and size of the largest polyp, with representative pictures taken 1
• Biopsy confirmation to exclude dysplasia, especially in cases with atypical features or in patients with familial adenomatous polyposis (FAP) 1
• Consideration of discontinuing long-term proton pump inhibitor (PPI) therapy, as it has been associated with the development of FGPs 1
• Follow-up endoscopy in 1-2 years may be reasonable for patients with numerous or large polyps to monitor for changes 1
• Patients with FAP require closer surveillance due to a slightly higher risk of dysplasia 1 The pathophysiology of FGPs involves cystic dilation of the fundic glands, often related to reduced acid secretion from prolonged PPI therapy or genetic factors in conditions like FAP 1. It is essential to note that FGPs are not associated with an increased risk of cancer, unless in the context of FAP syndrome, and larger FGPs (>1 cm) have been shown to be dysplastic in a small percentage of cases 1. Overall, the approach to FGPs should prioritize a thorough documentation and evaluation, with consideration of the patient's underlying medical conditions and medication use.

From the Research

Fundic Gland Polyps Characteristics

• Fundic gland polyps (FGPs) are commonly found in patients with familial adenomatous polyposis (FAP) and are considered benign 2
• FGPs are the most common gastric polyps and have been regarded as benign lesions with little malignant potential, except in the setting of FAP 3
• The prevalence of FGPs has been increasing along with the widespread and frequent use of proton pump inhibitors (PPIs) 3

Diagnosis and Management

• Biopsies are not routinely performed for FGPs, and conventional forceps may be time-consuming and/or yield nonrepresentative histology 2
• A novel endoscopic polypectomy surveillance (EPS) technique can improve early detection of dysplasia and gastric cancer in FAP patients with FGPs 2
• Upper endoscopic guidelines should include a more rigorous sampling method for FGPs, such as EPS, to optimize early detection of dysplasia and gastric cancer 2
• Histopathological evaluation is necessary if endoscopic findings different from ordinary FGPs are observed, regardless of their size 3

Risk Factors and Associations

• Endoscopic risk factors for cancer in FAP patients with FGPs include polyps >10 mm in size and carpeting of polyps 2
• FGPs with dysplasia or carcinoma (FGPD/CAs) are more common in middle-aged women receiving PPI therapy and without Helicobacter pylori (H. pylori) infection 3
• The association of gastric polyps with PPI use, H. pylori infection, risk of malignant transformation, and association with polyposis syndromes have been the focus of recent literature 4

Clinical Management

• All symptomatic polyps, polyps larger than 1 cm in size, and polyps later found to contain dysplasia or cancer should be completely removed 4
• Random biopsies from the intervening non-polypoid mucosa should be obtained 4
• Identification of multiple polyps of fundic gland type and/or concomitant dysplasia should raise suspicion for an underlying polyposis syndrome and prompt appropriate workup 4
• Surveillance is generally only indicated if there is confirmed dysplasia and/or carcinoma within the polyp itself or if preneoplastic changes are identified in the non-polypoid gastric mucosa 4