Gastric polyps: relationship of size and histology to cancer risk

Abstract

Objectives: Management of gastric polyps based on polyp size (< or > 2 cm), and histology obtained from forceps biopsy sampling is controversial. To illuminate this subject, the 4-yr experience with endoscopic management of gastric epithelial polyps at a university hospital and a Veterans Administration medical center was reviewed with histopathologic correlation.

Methods: A computer data-base was used to recall the endoscopic diagnosis of "gastric polyp." Endoscopy reports, video, and still photography were reviewed for data on polyp appearance, size, location, and management. These data had been entered prospectively as required by the Computer-Based Management System. Histopathology was reviewed by a second, blinded, pathologist. Gastric polyps of epithelial origin, at least 0.5 cm in diameter, and not associated with polyposis syndromes, were included.

Results: Thirty-five gastric polyps in 23 patients met inclusion criteria. Snare polypectomy was ultimately performed on 26, and complete resection with forceps biopsy alone on 9. On histopathology 31 polyps were hyperplastic and 4 were adenomas. Six hyperplastic polyps contained focal dysplasia. Among these, carcinoma in situ was identified in three, all <2.0 cm. Furthermore, forceps biopsy in two of these did not reveal the dysplastic components. One adenomatous polyp also contained carcinoma, also <2.0 cm.

Conclusions: These data emphasize that management based on polyp size or histology obtained from forceps biopsy sampling may be faulty. We recommend that gastric polyps >0.5 cm be removed in toto.