Management of gastric polyps: a pathology-based guide for gastroenterologists

Carmack, Susanne W.; Genta, Robert M.; Graham, David Y.; Lauwers, Gregory Y.

doi:10.1038/nrgastro.2009.70

Cited by 140 publications

(116 citation statements)

References 68 publications

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“…About 20% of biopsies taken from lesions endoscopically identified as polyps have no clearly defined pathological diagnosis (4). In the present study pathology revealed gastritis or normal gastric mucosa in 192 (28.8%) patients with mucosal elevations endoscopically appearing as polyps.…”

Section: Discussionmentioning

confidence: 83%

“…HP, FGP, and APs are epithelial polyps which form the classic gastric polyps. In addition, mucosal protrusions may be formed with gathered endocrine cells like in carcinoids or infiltrates like xanthomas, lymphoid proliferations or sometimes with mesenchymal proliferations like in GISTs, leiomyomas and inflammatory fibroid polyps (4). On the other hand small lesions which are less than 5 mm in size can be easily missed during endoscopic examination.…”

Section: Discussionmentioning

confidence: 99%

“…With the widespread use of endoscopy for diagnosis and treatment, the frequency of gastric polyps increases. In upper endoscopy polyps are detected in 2-5% (2,3) and 1-4% of patients who undergo gastric biopsy have gastric polyps (4). Various entities may appear endoscopically as a polyp or polypoid lesion.…”

Section: Introductionmentioning

confidence: 99%

“…Various entities may appear endoscopically as a polyp or polypoid lesion. Epithelial polyps (hyperplastic, fundic gland, and adenomatous) are the classic gastric polyps, but clusters of endocrine cells (carcinoids), infiltrates (xanthomas, lymphoid proliferations) or mesenchymal proliferations [gastrointestinal stromal tumors (GISTs), leiomyoma and inflammatory fibroid polyps (IFPs)] may create a mucosal protrusion (4).…”

Section: Introductionmentioning

confidence: 99%

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Gastric polyps and polypoid lesions: Retrospective analysis of 36650 endoscopic procedures in 29940 patients

Vatansever¹,

Akpınar²,

Alper³

et al. 2015

Turk J Gastroenterol

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Background/Aims: The frequency of gastric polyps increases with the widespread use of endoscopy for diagnosis and treatment. As gastric polyps can be malignant or premalignant, histopathological evaluation is needed. The aim of this study is to determine the prevalence and characteristics of gastric polyps in patients undergoing endoscopy. Materials and Methods: This study consisted of a retrospective analysis of 36650 consecutive endoscopy and associated pathology reports of 29940 patients between December 2005 and February 2012 in a tertiary-referral center. Results: Gastric polypoid lesions were detected in 666 (2.22%) patients. Hyperplastic polyps were the most common type of polyps (36.2%), followed by fundic gland polyps (8.3%), inflammatory fibroid polyps (2.4%) and adenomatous polyps (1.9%). Foveolar hyperplasia, neuroendocrine tumor, xanthoma, gastrointestinal stromal tumor, adenocarcinoma and lymphoma were less commonly seen. Malignant transformation was seen in 0.42% of hyperplastic polyps and in 23.1% of adenomatous polyps. Conclusion: Endoscopic appearance of gastric polyps can be variable, distinguishing macroscopically can be misleading. Because of their malignant potential histopathological evaluation is mandatory and polypectomy should be performed whenever possible.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Gastric polyps and polypoid lesions: Retrospective analysis of 36650 endoscopic procedures in 29940 patients

Vatansever¹,

Akpınar²,

Alper³

et al. 2015

Turk J Gastroenterol

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“…Equally speculative is their potential to transform into malignancy. Given their histological resemblance to hyperplastic polyps which are now considered to harbor such a risk, these lesions may be expected to behave similarly [12]. The fact that there is no known increase in the risk of gastric cancers in cirrhosis or PH is reassuring for the present.…”

mentioning

confidence: 91%

Portal hypertensive polyp—what is in a name?

Pai

2013

Indian J Gastroenterol

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Draining as it does into the portal venous system, it is not surprising that most of the gastrointestinal tract should show a variety of changes in portal hypertension (PH). The latest entry to this slowly lengthening list of abnormalities is the 'portal hypertensive polyp' (PHP), described in two reports in the current issue of this Journal [1, 2]. As with any newly described entity, a bevy of questions immediately comes up.PHP have been reported to occur in the stomach and less commonly elsewhere in the bowel [3,4]. They have most often been associated with cirrhotic PH but do occur in extrahepatic portal venous obstruction too [5]. Are they a distinct entity? The reports under review, dealing with gastric and duodenal lesions, and a handful of preceding ones make a case that they are. However, there have been no clear diagnostic criteria for PHP. Microscopically, gastric PHP have been diagnosed based on the presence of variable foveolar hyperplasia of the epithelium along with underlying vascular proliferation. So the question arises: are these lesions unique to PH or do they simply represent hyperplastic polyps arising on a background of vascular changes of PH such as portal hypertensive gastropathy (PHG) or gastric antral vascular ectasia (GAVE)? The latter possibility certainly cannot be ruled out. In their retrospective analysis, on 631 patients with PH, Amarapurkar et al. found gastric and duodenal polyps in 16 (2.53 %) patients. Nine of these were diagnosed as PHP, six as hyperplastic polyp, and one as fundic gland polyp. On comparing PHP with PHG mucosa devoid of polyps, the authors found that the density and diameter of capillaries in the lamina propria were similar but that such changes were significantly more frequent (p<0.001) in these two groups compared to polyps in patients without PH. The morphometric and special staining characteristics of PHP presented in the paper do not provide any support to the contention that the vascular changes seen in PHP are distinct from those seen in PHG or GAVE. Nor does the comparison, less detailed nonetheless, between hyperplastic polyps and PHP as reported by Lam et al. in an earlier report confirms that these two lesions are distinct. Did the six hyperplastic polyps reported by Amarapurkar et al. differ from the PHP in any characteristics other than the vascularity? The paper does not comment on this. Again, there was no difference in the age, gender, the frequency of polyps, and their histological types in the portal hypertensive and non-portal hypertensive groups. The fact that the prevalence of all types of polyps in the portal hypertensive and non-portal hypertensive group (2.53 % vs. 3.3 %, p=0.4) was similar also casts doubts as to whether these are unique lesions developing in the presence of PH over and above the other types of polyps seen in the general population. Also, PHP in the stomach and those in the small bowel may not show similar histological features except for the increased, dilated subepithelial capillaries. For example, some earlier repo...

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