Gastric polyps are usually found incidentally on upper gastrointestinal endoscopy performed for an unrelated indication and only in rare cases do they cause symptoms. Nevertheless, the diagnosis and appropriate management of gastric polyps are important, as some polyps have malignant potential.
This topic will review the epidemiology, clinical manifestations, histopathology, and management of gastric polyps. Our recommendations are largely consistent with the American Society for Gastrointestinal Endoscopy (ASGE) guidelines [1,2]. The clinical manifestations, diagnosis and management of gastric gastrointestinal stromal tumors (GISTs), leiomyomas, lipomas, and other subepithelial lesions that may have a polypoid appearance on upper endoscopy are discussed in detail, separately. (See "Endoscopic ultrasound for the characterization of subepithelial lesions of the upper gastrointestinal tract" and "Epidemiology, classification, clinical presentation, prognostic features, and diagnostic work-up of gastrointestinal mesenchymal neoplasms including GIST" and "Local treatment for gastrointestinal stromal tumors, leiomyomas, and leiomyosarcomas of the gastrointestinal tract".)
Gastric polyps are found in approximately 6 percent of upper gastrointestinal endoscopic procedures in the United States . However, lower rates have been reported in other countries [4,5]. Hyperplastic polyps and adenomas are relatively more prevalent as compared with fundic gland polyps in regions where Helicobacter pylori infection is common [4-6]. In contrast, in western countries, where the prevalence of H. pylori infection is lower and proton pump inhibitor (PPI) use is common, the most commonly encountered polyps are fundic gland polyps (picture 1A-B) [3,6].
The initial approach to gastric polyps should include an evaluation of both polyp histology and the surrounding mucosa.
●Evaluation of polyp histology – In patients with small solitary polyps, either biopsy samples should be obtained or polypectomy performed so that the polyp can be examined microscopically for histologic characterization [7-11]. Polypectomy should be performed for all known neoplastic polyps and for all polyps ≥1 cm in diameter, as biopsies alone cannot exclude foci of high-grade dysplasia or early gastric cancer . In patients with multiple polyps, the largest polyp should be excised and representative biopsies obtained from the remaining polyps [1,2]. In patients with sessile polyps, endoscopic mucosal resection may be needed to provide an accurate histological assessment and achieve complete resection. Further management should be based on histology . (See "Overview of endoscopic resection of gastrointestinal tumors" and 'Types of gastric polyps and specific management' below.)