Gastric Hyperplastic Polyps: A Benign Entity? Analysis of Recurrence and Neoplastic Transformation in a Cohort Study

Abstract

<b><i>Introduction:</i></b> Hyperplastic polyps represent 30–93% of all gastric epithelial polyps. They are generally detected as innocuous incidental findings; however, they have a risk of neoplastic transformation and recurrence. Frequency and risk factors for neoplastic transformation and recurrence are not well established and are fields of ongoing interest. This study aims to evaluate the frequency of and identify the risk factors for recurrence and neoplastic change of gastric hyperplastic polyps (GHP). <b><i>Methods:</i></b> A single-centre retrospective cohort study including consecutive patients who underwent endoscopic resection of GHP from January 2009 to June 2020. Demographic, endoscopic, and histopathologic data was retrieved from the electronic medical records. <b><i>Results:</i></b> A total of 195 patients were included (56% women; median age 67 [35–87] years). The median size of GHP was 10 (3–50) mm, 62% (<i>n</i> = 120) were sessile, 61% (<i>n</i> = 119) were located in the antrum, and 36% (<i>n</i> = 71) had synchronous lesions. Recurrence rate after endoscopic resection was 23% (<i>n</i> = 26). In multivariate analysis, antrum location was the only risk factor for recurrence (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.1–8.1). Overall, 5.1% (<i>n</i> = 10) GHP showed neoplastic transformation, with low-grade dysplasia in 5, high-grade dysplasia in 4, and adenocarcinoma in 1. In multivariate analysis, a size >25 mm (OR 84; 95% CI 7.4–954) and the presence of intestinal metaplasia (OR 7.6; 95% CI 1.0–55) and dysplasia (OR 86; 95% CI 10–741) in adjacent mucosa were associated with an increased risk of neoplastic transformation. Recurrence was not associated with neoplastic transformation (OR 1.1; 95% CI 0.2–5.9). <b><i>Discussion:</i></b> Our results confirmed the risk of recurrence and neoplastic transformation of GHP. Antrum location was a predictor of recurrence. The risk of neoplastic change was increased in large lesions and with intestinal metaplasia and dysplasia in adjacent mucosa. More frequent endoscopic surveillance may be required in these subgroups of GHP.

How to improve the diagnosis of neoplastic transformation of gastric hyperplastic polyps in the context of autoimmune gastritis?: A case report and lierature review

“…[7,11] In general, GHP occurs in the abnormal background mucosa, particularly in AIG. Stimulated by high levels of gastrin, the association between GHP and AIG is well verified [13] and the data demonstrated that 12% GHP related to AIG. [14] The development of cancer is deemed to a multi-step process through hyperplasia-dysplasia-carcinoma sequence, [15] and AIG confers an increased risk of intestinal-type gastric cancer.…”

Case Report the Neoplastic Transformation of Gastric Hyperplastic Polyp in a Context of Autoimmune Gastritis: Improving the Diagnosis

“…In general, GHP occurs in the abnormal background mucosa, particularly in AIG. Stimulated by high levels of gastrin, the association between GHP and AIG is well veri ed [13] and the data demonstrated that 12% GHP related to AIG [14]. The development of cancer is deemed to a multi-step process through hyperplasia-dysplasia-carcinoma sequence [15], and AIG confers an increased risk of intestinal-type gastric cancer [16].…”

Feasibility and efficacy of endoscopy with blue laser imaging for the detection and diagnosis of cardia polyps: A single‐center randomized controlled study

“…The detection rate of early cardia cancer has been increasing in recent years, 3,4 together with an elevated detection rate of cardia polyps, which ranges from 0.35% to 0.46% using unsedated and sedated endoscopic examinations 5 . Among all patients with gastric polyps, 11% are found to have cardia polyps 6 . Cardia polyps are defined as pedunculated or sessile lesions that originate from the mucosal epithelium of the cardia that protrude into the cavity 7 .…”