asymptomatic.
90% found incidently.
large polyps can present with bleeding, anaemia, abdominal pain and gastric outlet obstruction. dysplasia can only be determined by histology, so all type of polyps should be sampled.
types of plyps:
1- benign epithelial gastric polyps:
i. sporadic fundic gland polyps.
ii. hyperplastic polyps.
iii. adenomatous polyps.
2-Non-mucosal intra-mural polyps:
i. GIST.
ii. GNET.
the management of gastric polyps 2010:
1- all types of gastric polyps detected at endoscopy need to be sampled.
2- all gastric adenomatous polyps should be removed when it is safe to do so.
3- FAP should be considered as a diagnosis in young patients with numerous fundic gands polyps.
4- repeat gastroscopy should be performed at one year if:
-Polyps with dysplasia that has not been removed.
-following complete polypectomy in high risk polyps.
BSC the management of gastric polyps guidelines.
Usually multiple, sessile, tansparent polyps,1-5mm in diameter, located in the body and the fundus.
Microscopically they show cystically dilated glands lined by gastric body type mucosa.
Q: A 25-year-old gentleman underwent an endoscopy for dyspepsia. Endoscopy showed several gastric fundic polyps (over 20). What would be the next most optimal step:-
1- Do nothing
2- Repeat endoscopy every year
3-HP eradication
4- FAP gene testing and colonoscopy
5- Enteroscopy
Sporadic fundic glands are seen in about 1% endoscopies and are due to mutation in beta catenin. No cancer risk is defined and they can be left alone, whereas, fundic gland polyposis in Familial Adenomatous Polyposis (FAP) is due to mutation in the FAP gene. Dysplasia is seldom seen in sporadic fundic gland polyps.
ReplyDeleteHistologically, fundic gland polyps are hamartomas.
Gastric fundic polyps more than 10 in number are usually associated with FAP or attenuated FAP. Risk of gastric cancer is very low in these cases, but the risk of colon cancer is almost 100% and hence regular colonoscopic surveillance is recommended in these cases. If associated with FAP, some people recommend selective polypectomy of the fundic glands and three to five yearly surveillance endoscopy.