Introduction British Society of Gastroenterology (BSG) released guidelines for management of gastric polyps in 20101 and main recommendations are to biopsy all polyps, complete adenoma removal and follow-up, test and treat H Pylori (if suspicious of hyperplastic or adenomatous). Though polyps are noted in 1%–2% of any gastroscopy, studies have reported adenomas in up to 6.6% of all polyps.2 While colorectal polyps have rigorous management pathways, there is huge disparity in assessment and treatment of gastric polyps that also follow the adenoma-carcinoma sequence. Our study aimed to compare our current practice with BSG recommendations and possibly devise a standard local Proforma to ensure best practice.
Methods A retrospective audit was conducted in a teaching hospital on all gastric polyps noted during upper GI endoscopy performed between January 2009 and October 2011. Data identified by “Endoscribe” software was compared with BSG guidelines. Demographics including the size of polyp, whether biopsy taken, histological and endoscopic diagnosis as mentioned in the report, documented usage of proton pump inhibitors and urease test result (if done) are collected.
Results Out of 161 patients reported to have gastric polyps, only 61% (98) had at least one biopsy taken. Endoscopic diagnosis of polyp types were mentioned in the report only in 17/160 procedures (16 fundic gland and 1 hyperplastic) and it correlated with histological diagnosis in 64.3%. The distribution of various polyp types by histology is shown in Abstract PMO-200 table 1 and adenomas comprised only 3.06% of total number of polyps biopsied. 33 polyps were >5 mm but of varied pathology. Proton pump inhibitors usage was documented in 23 patients and was associated with fundic gland polyps in 71.4%. 28 patients had urease test done but only one was positive (Histology of polyp showed chronic gastritis).
Conclusion There is poor compliance with BSG recommendations, especially with regards to taking biopsies from gastric polyps. There is evidence for gross under-reporting of polyps which can miss early cancers. We have now designed a local hospital pathway for management of gastric polyps adapted from the guideline and will complete the audit cycle with the new protocol.
Competing interests None declared.
References 1. Goddard AF, Badreldin R, Pritchard DM, et al. The management of gastric polyps. Gut 2010;59:1270–6.
2. Archimandritis A, Spiliadis C, Tzivras M, et al. Gastric epithelial polyps: a retrospective endoscopic study of 12974 symptomatic patients. Italian J of Gastroenterology 1996;28:387–90.