Polyps, Gastric

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

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

Epidemiology

• • 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

Symptoms and Signs

• • Most asymptomatic

  • Vague epigastric discomfort

  • Dyspepsia

  • Occult GI bleeding

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

Laboratory Findings

• • 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

Imaging Findings

• • 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

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

Rule Out

• • Gastric cancer

• • 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

When to Admit

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

  • Severe bleeding from polyp

Surgery

• • Endoscopic removal can be performed successfully in most cases

  • Laparotomy and gastrotomy if endoscopy is unsuccessful

Indications

• • Failure of endoscopic polypectomy

  • Cancer found in polyp

  • Gastrectomy may be required for multiple polyps

Treatment Monitoring

• • Surveillance endoscopy for patients with gastric adenomas

Complications

• • Occult GI bleeding

  • Gastric outlet obstruction

Prognosis

• • Recurrent polyps are uncommon

References