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Costa D, Ramai D, Tringali A. Novel classification of gastric polyps: The good, the bad and the ugly. World J Gastroenterol 2024; 30:3640-3653. [PMID: 39192997 PMCID: PMC11346164 DOI: 10.3748/wjg.v30.i31.3640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/19/2024] [Accepted: 08/02/2024] [Indexed: 08/13/2024] Open
Abstract
Gastric polyps (GPs) are increasingly common. On upper endoscopy, they should be examined with white light and occasionally chromoendoscopy, and their morphology classified according to the Paris classification. Most GPs have a typical endoscopic appearance and can be associated with diseases like Helicobacter pylori infection. Histological examination is necessary for an accurate diagnosis. While most polyps are non-neoplastic and do not require treatment, some carry a risk of malignancy or are already malignant. Therefore, understanding the diagnosis, classification, and management of GPs is crucial for patient prognostication. Our new classification categorizes GPs into "good", "bad", and "ugly" based on their likelihood of becoming malignant. We aim to provide descriptions of the endoscopic appearance, pathology, treatment, and follow-up for different GPs, as well as clinical management flowcharts.
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Affiliation(s)
- Deborah Costa
- Department of Digestive Endoscopy and Gastroenterology, AULSS2, Conegliano Hospital, Conegliano 31015, Italy
| | - Daryl Ramai
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Alberto Tringali
- Department of Digestive Endoscopy and Gastroenterology, AULSS2, Conegliano Hospital, Conegliano 31015, Italy
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2
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Lam SK, Lau GKK. Proton pump inhibitors are not associated with fundic gland polyps - a systematic review that takes into consideration all known confounders. Eur J Gastroenterol Hepatol 2024; 36:831-844. [PMID: 38829941 PMCID: PMC11146189 DOI: 10.1097/meg.0000000000002788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/21/2024] [Indexed: 06/05/2024]
Abstract
Sporadic fundic gland polyps (FGPs) progress, albeit rarely, to dysplasia and cancer. Two meta-analyses, including 8 and 11 studies, concluded that proton pump inhibitors (PPIs) were associated with FGPs. Intervention is considered unnecessary when FGPs have a background of PPIs use. Both meta-analyses, however, disregarded known confounders: age, sex, endoscopy indications, study design (prospective or retrospective), duration of PPI use, and H. pylori infection. Confounders are known to invalidate meta-analyses. We followed PRIXMA guidelines and searched the literature for studies on FGPs in PPI-users and PPI-nonusers. In the 22 studies searched, we compared FGPs in PPI-users (n = 6534) and PPI-nonusers (n = 41 115). Heterogeneity was significant (Cochran Q = 277.8, P < 0.0001; I2 = 92.8%), annulling meta-analysis performed by blanket tallying. To offset the above confounders, we matched PPI-users and PPI-nonusers by (a) age and sex (n = 4300 and 29 307, respectively) and (b) their propensity scores derived from the confounders (n = 2950 and 4729, respectively). After both matching, FGPs were not significantly different between PPI-users and PPI-nonusers [odds ratio (OR) = 1.1, P = 0.3078; OR = 0.9, P = 0.3258, respectively]. Furthermore, FGP frequency did not correlate with increasing duration of PPI use (Pearson and Spearman correlation coefficients = 0.1162, 0.0386, P < 0.6064, 0.8646, respectively); it was not significantly different between any of the duration periods of observation, namely, <10, 10-20, 20-40, >40 months, nor was it significantly different between PPI-users and PPI-nonusers within each duration period (P > 0.05). We conclude that PPIs are not associated with FGPs, implying that a background history of PPI use is not a justification for nonintervention in the management of FGPs.
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Affiliation(s)
- Shiu Kum Lam
- Gastroenterology & Hepatology of The Humanity & Health Medical Centre
- Former Chair & Dean of Medicine, The University of Hong Kong
| | - George Ka Kit Lau
- Gastroenterology & Hepatology of The Humanity & Health Medical Centre, Hong Kong, Hong Kong
- Liver Diseases & Transplant Centre, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
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3
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Sami AS, Sylvester FA, Attard T, Mir S. Fundic Gland Polyps: Strategizing a Surveillance Framework for Children and Adolescents. J Pediatr Gastroenterol Nutr 2023; 77:439-441. [PMID: 37440343 DOI: 10.1097/mpg.0000000000003891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Ahmad Salah Sami
- From the Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Francisco A Sylvester
- From the Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Thomas Attard
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Missouri School of Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Sabina Mir
- From the Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Sano W, Inoue F, Hirata D, Iwatate M, Hattori S, Fujita M, Sano Y. Sporadic fundic gland polyps with dysplasia or carcinoma: Clinical and endoscopic characteristics. World J Gastrointest Oncol 2021. [DOI: 10.4251/wjgo.v13.i7.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Sano W, Inoue F, Hirata D, Iwatate M, Hattori S, Fujita M, Sano Y. Sporadic fundic gland polyps with dysplasia or carcinoma: Clinical and endoscopic characteristics. World J Gastrointest Oncol 2021; 13:662-672. [PMID: 34322195 PMCID: PMC8299935 DOI: 10.4251/wjgo.v13.i7.662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/25/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Fundic gland polyps (FGPs) are the most common gastric polyps and have been regarded as benign lesions with little malignant potential, except in the setting of familial adenomatous polyposis. However, in recent years, the prevalence of FGPs has been increasing along with the widespread and frequent use of proton pump inhibitors (PPIs). To date, several cases of FGPs with dysplasia or carcinoma (FGPD/CAs) have been reported. In this review, we evaluated the clinical and endoscopic characteristics of sporadic FGPD/CAs. Majority of the patients with sporadic FGPD/CAs were middle-aged women receiving PPI therapy and without Helicobacter pylori (H. pylori) infection. Majority of the sporadic FGPD/ CAs occurred in the body of the stomach and were sessile and small with a mean size of 5.4 mm. The sporadic FGPs with carcinoma showed redness, irregular surface structure, depression, or erosion during white light observation and irregular microvessels on the lesion surface during magnifying narrow-band imaging. In addition, sporadic FGPs, even with dysplasia, are likely to progress to cancer slowly. Therefore, frequent endoscopy is not required for patients with sporadic FGPs. However, histopathological evaluation is necessary if endoscopic findings different from ordinary FGPs are observed, regardless of their size. In the future, the prevalence of FGPs is expected to further increase along with the widespread and frequent use of PPIs and decreasing infection rate of H. pylori. Currently, it is unclear whether FGPD/CAs will also increase in the same way as FGPs. However, the trends of these lesions warrant further attention in the future.
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Affiliation(s)
- Wataru Sano
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Fumihiro Inoue
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Daizen Hirata
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Mineo Iwatate
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Santa Hattori
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Mikio Fujita
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
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6
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Gastritis, Gastric Polyps and Gastric Cancer. Int J Mol Sci 2021; 22:ijms22126548. [PMID: 34207192 PMCID: PMC8234857 DOI: 10.3390/ijms22126548] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
Gastric cancer is still an important disease causing many deaths worldwide, although there has been a marked reduction in prevalence during the last few decades. The decline in gastric cancer prevalence is due to a reduction in Helicobacter pylori infection which has occurred for at least 50 years. The most probable mechanism for the carcinogenic effect of H. pylori is hypergastrinemia since H. pylori infected individuals do not have increased risk of gastric cancer before the development of oxyntic atrophy. When atrophy has developed, the carcinogenic process continues independent of H. pylori. Autoimmune gastritis also induces oxyntic atrophy leading to marked hypergastrinemia and development of ECL cell neoplasia as well as adenocarcinoma. Similarly, long-term treatment with efficient inhibitors of acid secretion like the proton pump inhibitors (PPIs) predisposes to ECL cell neoplasia of a different degree of malignancy. Contrasting the colon where most cancers develop from polyps, most polyps in the stomach have a low malignant potential. Nevertheless, gastric polyps may also give rise to cancer and have some risk factors and mechanisms in common with gastric cancer. In this overview the most common gastric polyps, i.e., hyperplastic polyps, adenomatous polyps and fundic gland polyps will be discussed with respect to etiology and particularly use of PPIs and relation to gastric carcinogenesis.
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Shibukawa N, Wakahara Y, Ouchi S, Wakamatsu S, Kaneko A. Synchronous Three Gastric Fundic Gland Polyps with Low-grade Dysplasia Treated with Endoscopic Mucosal Resection after Being Diagnosed to Be Tubular Adenocarcinoma Based on a Biopsy Specimen. Intern Med 2019; 58:1871-1875. [PMID: 30918177 PMCID: PMC6663528 DOI: 10.2169/internalmedicine.2081-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 51-year-old woman had been taking proton pump inhibitor since August 2008. In May, 2016, endoscopic findings showed no atrophy and no intestinal metaplasia in the stomach, and multiple fundic gland polyps were identified in the stomach. A biopsy of a pedunculated polyp measuring 10 millimeters in diameter at the greater curvature of the middle gastric body demonstrated well differentiated tubular adenocarcinoma. In July 2016, we treated this lesion and two other semipedunculated polyps located near the first polyp and also measuring 10 mm in diameter by endoscopic mucosal resection. The final diagnosis of all lesions was a fundic gland polyp with low grade dysplasia and the cutting end was negative.
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Affiliation(s)
| | - Yuhei Wakahara
- Department of Gastroenterology, NTT West Osaka Hospital, Japan
| | - Shohei Ouchi
- Department of Gastroenterology, NTT West Osaka Hospital, Japan
| | - Shuji Wakamatsu
- Department of Gastroenterology, NTT West Osaka Hospital, Japan
| | - Akira Kaneko
- Department of Gastroenterology, NTT West Osaka Hospital, Japan
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Dinarvand P, Davaro EP, Doan JV, Ising ME, Evans NR, Phillips NJ, Lai J, Guzman MA. Familial Adenomatous Polyposis Syndrome: An Update and Review of Extraintestinal Manifestations. Arch Pathol Lab Med 2019; 143:1382-1398. [PMID: 31070935 DOI: 10.5858/arpa.2018-0570-ra] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Familial adenomatous polyposis (FAP) is a rare genetic disorder with autosomal dominant inheritance, defined by numerous adenomatous polyps, which inevitably progress to colorectal carcinoma unless detected and managed early. Greater than 70% of patients with this syndrome also develop extraintestinal manifestations, such as multiple osteomas, dental abnormalities, and a variety of other lesions located throughout the body. These manifestations have historically been subcategorized as Gardner syndrome, Turcot syndrome, or gastric adenocarcinoma and proximal polyposis of the stomach. Recent studies, however, correlate the severity of gastrointestinal disease and the prominence of extraintestinal findings to specific mutations within the adenomatous polyposis coli gene (APC), supporting a spectrum of disease as opposed to subcategorization. Advances in immunohistochemical and molecular techniques shed new light on the origin, classification, and progression risk of different entities associated with FAP. OBJECTIVE.— To provide a comprehensive clinicopathologic review of neoplastic and nonneoplastic entities associated with FAP syndrome, with emphasis on recent developments in immunohistochemical and molecular profiles of extraintestinal manifestations in the thyroid, skin, soft tissue, bone, central nervous system, liver, and pancreas, and the subsequent changes in classification schemes and risk stratification. DATA SOURCES.— This review will be based on peer-reviewed literature and the authors' experiences. CONCLUSIONS.— In this review we will provide an update on the clinicopathologic manifestations, immunohistochemical profiles, molecular features, and prognosis of entities seen in FAP, with a focus on routine recognition and appropriate workup of extraintestinal manifestations.
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Affiliation(s)
- Peyman Dinarvand
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Elizabeth P Davaro
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - James V Doan
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Mary E Ising
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Neil R Evans
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Nancy J Phillips
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Jinping Lai
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
| | - Miguel A Guzman
- From the Departments of Pathology (Drs Dinarvand, Davaro, Doan, Phillips, and Guzman and Ms Ising) and Internal Medicine (Dr Evans), Saint Louis University School of Medicine, Saint Louis, Missouri; and the Department of Pathology, University of Florida, College of Medicine, Gainesville (Dr Lai)
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Singh A, Steinhagen E, Katona BW. Approach to upper gastrointestinal tract lesions in familial adenomatous polyposis. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Straub SF, Drage MG, Gonzalez RS. Comparison of dysplastic fundic gland polyps in patients with and without familial adenomatous polyposis. Histopathology 2018; 72:1172-1179. [PMID: 29436014 DOI: 10.1111/his.13485] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/07/2018] [Indexed: 12/18/2022]
Abstract
AIMS Dysplastic fundic gland polyps (d-FGPs) typically arise in patients with familial adenomatous polyposis (FAP) but may occur in non-syndromic patients. They rarely become malignant, but their significance is unclear, especially in non-syndromic patients. We aimed to compare d-FGPs in patients with and without FAP, using clinicopathologic findings and β-catenin immunohistochemistry (IHC). METHODS AND RESULTS We identified 124 fundic gland polyps with low-grade dysplasia (LGD) or high-grade dysplasia (HGD) or indefinite for dysplasia (IFD) from 66 patients (27 with FAP; 39 non-syndromic). We recorded patient sex, age at first d-FGP, time until subsequent d-FGP (if any), history of non-gastric cancer (no patients had gastric cancer), proton-pump inhibitor use, and the presence of Helicobacter pylori. β-Catenin IHC was performed on cases with available blocks. The mean age at d-FGP diagnosis was 31 years for FAP patients and 61 years for non-syndromic patients (P < 0.0001). Sixteen FAP patients (59%) developed at least one subsequent d-FGP, as compared with 10 (27%) non-syndromic patients (P = 0.0099). The median time between d-FGP detection was 11.5 months in FAP patients and 7 months in non-syndromic patients (P = 0.82). Six FAP patients (22%) and 17 non-syndromic patients (44%) had non-gastric malignancies (P = 0.11). β-Catenin IHC showed nuclear positivity in 14 of 112 (13%) d-FGPs: 12 of 94 with LGD, two of three with HGD, and none of 15 with IFD polyps. CONCLUSIONS Familial adenomatous polyposis patients develop d-FGPs earlier and more often develop additional ones than non-syndromic patients. d-FGPs in FAP and non-syndromic patients have similar low rates of β-catenin nuclear IHC positivity. FAP and non-syndromic patients developed non-gastric cancers at similar rates, suggesting that d-FGPs may portend a general increased risk of carcinogenesis in non-syndromic patients.
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Affiliation(s)
- Shana F Straub
- Office of the Chief Medical Examiner of New York City, New York, NY, USA
| | - Michael G Drage
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Cheesman AR, Greenwald DA, Shah SC. Current Management of Benign Epithelial Gastric Polyps. ACTA ACUST UNITED AC 2017; 15:676-690. [DOI: 10.1007/s11938-017-0159-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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