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

Nature Reviews Gastroenterology & Hepatology volume 6, pages 331–341 (2009)Cite this article

Abstract

1–4% of patients who undergo gastric biopsy have gastric polyps. These lesions may be true epithelial polyps, heterotopias, lymphoid tissue, or stromal lesions. Hyperplastic polyps, which arise in patients with underlying gastritis, and fundic-gland polyps, which are associated with PPI therapy, are the most common gastric polyps; however, prevalence varies widely relative to the local prevalence of Helicobacter pylori infection and use of PPI therapy. Some polyps have characteristic topography, size, and endoscopic appearance. Approximately 20% of biopsy specimens identified endoscopically as polyps have no definite pathological diagnosis. Evaluation of the phenotype of the gastric mucosa that surrounds a lesion will provide significant information crucial to the evaluation, diagnosis and management of a patient. The presence of a gastric adenoma should prompt the search for a coexistent carcinoma. The endoscopic characteristics, histopathology, pathogenesis, and management recommendations of polyps and common polypoid lesions in the stomach are discussed in this Review.

Key Points

  • Multiple entities may present as a gastric polypoid lesion, and many have subtle yet characteristic endoscopic features

  • In Western countries, fundic-gland polyps are now more common than hyperplastic polyps, resulting from the increase in PPI therapy and decrease in gastritis associated with Helicobacter pylori infection

  • Biopsy specimens of the gastric mucosa adjacent to a lesion are extremely important in establishing an etiology when hyperplastic polyps, adenomas, and carcinoids are present

  • Surveillance is indicated in patients with polyposis syndromes and adenomas; patients with gastrointestinal stromal tumors and carcinoids may be followed up endoscopically, but management approach should be tailored to each individual

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Figure 1: A fundic-gland polyp.
Figure 2: A hyperplastic polyp.
Figure 3: An adenomatous polyp.
Figure 4: An inflammatory fibroid polyp.
Figure 5: A gastrointestinal stromal tumor.
Figure 6: A carcinoid.
Figure 7: A xanthoma.
Figure 8: A pancreatic heterotopia.

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Acknowledgements

We would like to thank Dr A. Horiuchi, Showa Inan General Hospital, Komagane, Japan for providing the endoscopic photographs of a gastric adenoma (Figure 3a) and a gastric carcinoid (Figure 6a). Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. Veterans Affairs North Texas Health Care System, University of Southwestern Medical Center, Dallas, TX, USA

    Susanne W. Carmack & Robert M. Genta

  2. Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA

    David Y. Graham

  3. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Gregory Y. Lauwers

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Correspondence to Robert M. Genta.

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Carmack, S., Genta, R., Graham, D. et al. Management of gastric polyps: a pathology-based guide for gastroenterologists. Nat Rev Gastroenterol Hepatol 6, 331–341 (2009). https://doi.org/10.1038/nrgastro.2009.70

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