Introduction Gastric polyps are usually benign and >90% are found incidentally at endoscopy, most common type being fundic gland polyps (FGP).1 Current guideline advocates biopsy for all types of gastric polyps.1 Literature review failed to demonstrate a strong link between proton pump inhibitors (PPIs) and FGPs. BSG guidelines also suggest testing and eradicating Helicobacter pylori in patients with hyperplastic polyps. Our study is to analyse gastric polyp subtypes and management.
Methods Retrospective case note analysis of patients with gastric polyps between January 2009 and December 2010 at James Paget University Hospital. Data collected: Age, gender, endoscopic appearance, histology, association with PPI, management and follow-up.
Results Total number of patients was 79. Mean age was 67.1 (38–89 yrs). 60.8% were women (n=48). Reflux symptom was the most common indication for OGD (36.7%;n=29). 22.8% (n=18) had single polyp, 58.2% (n=46) had multiple polyps (>3). Majority had sessile appearance at OGD 62.0% (n=49). Most polyps were found in the gastric body 45.5% (n=36), followed by fundus 20.3% (n=16). 54.4% (n=43) polyps were estimated <5 mm, compared to 6.3% (n=5) over 10 mm. Biopsy was performed in 94.9% (n=75) gastric polyps. 2.5% (n=2) polyps were not biopsied due to typical appearance of FGP. Fundic gland polyp (FGP) was the most common histopathological diagnosis (73.4%; n=58), followed by hyperplastic polyp (11.4%; n=9). Neither adenoma nor neoplasic lesions were detected. Information on PPIs use was obtained in only 60.8% patients (n=48): 33.3% (n=16) were not on PPIs; 35.4% (n=17) were on PPIs for an uncertain length of time; 8.3% (n=4) were on PPI's for <6 months; and 22.9% (n=11) were more than 6 months. The prevalences of FGPs in the above groups were 75%, 76.5%, 75% and 90.0% respectively. 3.8% polyps (n=3) were removed, all of which were greater than 10 mm. H pylori test was performed in 34.2% (n=27) of the patients. All nine patients (100%) with hyperplastic polyps underwent the test. 87.3% (n=69) patients had no follow-up. Only 2.5% (n=2) had repeat OGD.
Conclusion The local practice in management and follow-up seems to be concordant with the current guidelines. In this study, all gastric polyps were benign, with FGPs as the most frequent diagnosis (73.8%). It raises the question whether a routine biopsy is necessary for polyps with typical FGP appearance. There is no definitive link between PPIs and FGPs (75% FGPs in non-PPI users compared with 80.5% in PPI users). However, the percentage of FGPs presented in long-term PPI users is slightly higher (90%).
Competing interests None declared.
Reference 1. Goddard AF, Badreldin R, Pritchard DM, et al. The management of gastric polyps. Gut 2010;59:1270–6.
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