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  • • Evidence of polyp in the stomach on upper GI endoscopy

    • May be associated with gastric outlet obstruction if located in the distal stomach

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Epidemiology

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  • Hyperplastic polyps (> 80%)

    • -Represent overgrowth of normal epithelium

      -Not true neoplasms

      -No relationship to gastric cancer

    Adenomatous polyps

    • -30% contain a focus of adenocarcinoma

      -The incidence of cancer in an adenomatous polyp rises with increasing size; those with a stalk and those < 2 cm are usually not malignant

      -About 10% of benign adenomatous polyps undergo malignant change during prolonged follow-up

      -Adenocarcinoma found elsewhere in the stomach in 20% of patients with a benign adenomatous polyp

    • Polyps located in distal stomach are more apt to cause symptoms

    • Occur predominantly in the elderly

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Symptoms and Signs

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  • • Most asymptomatic

    • Vague epigastric discomfort

    • Dyspepsia

    • Occult GI bleeding

    • Gastric outlet obstruction with nausea and vomiting if polyp is located in the distal stomach

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Laboratory Findings

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  • • Anemia may develop from chronic blood loss or deficient iron absorption

    • Over 90% of patients are achlorhydric after maximal stimulation

    • Vitamin B12 absorption is deficient in 25%, although megaloblastic anemia is present in only a few

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Imaging Findings

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  • Upper GI endoscopy: Reveals presence of gastric polyp

    • Gastric polyp may also be visible on upper GI contrast radiographic study

    • In all cases, histologic diagnosis is required by endoscopy and polypectomy or biopsy

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  • • Most gastric polyps are discovered incidentally on upper GI radiographic or endoscopic studies

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Rule Out

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  • • Gastric cancer

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  • • Upper GI endoscopy or contrast radiography will detect the lesion

    • Endoscopy should be performed in all cases for histologic diagnosis and to exclude cancer

    • Endoscopy may be diagnostic and therapeutic

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When to Admit

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  • • High-grade gastric outlet obstruction preventing adequate enteral nutrition

    • Severe bleeding from polyp

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Surgery

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  • • Endoscopic removal can be performed successfully in most cases

    • Laparotomy and gastrotomy if endoscopy is unsuccessful

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Indications

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  • • Failure of endoscopic polypectomy

    • Cancer found in polyp

    • Gastrectomy may be required for multiple polyps

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Treatment Monitoring

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  • • Surveillance endoscopy for patients with gastric adenomas

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Complications

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  • • Occult GI bleeding

    • Gastric outlet obstruction

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Prognosis

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  • • Recurrent polyps are uncommon

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References

Abraham SC et al. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol. 2001;25:500.  [PubMed: 11257625]

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