2144 Gastric Hyperplastic Polyps Are Resistant to Treatment by Endoscopic Submucosal Dissection

Abstract

INTRODUCTION: Hyperplastic gastric polyps represent a subset of gastric polyps that are known to have malignant potential, with 5-19% harboring focal dysplastic changes, suggesting there would be a benefit to resection. Size > 1.0 cm and pedunculated morphology have been shown as clear risk factors for malignant transformation. Current ASGE recommendations state that any hyperplastic polyp > 0.5 cm be resected. Despite these recommendations, it is unclear how successful current endoscopic techniques are in the long-term management of these polyps. In this study, we sought to better understand if endoscopic submucosal dissection (ESD) would be successful in sustained removal of hyperplastic polyps. CASE DESCRIPTION/METHODS: We conducted a retrospective review of all patients between 2013 and 2019 who underwent ESD at our institution. Those who underwent ESD for treatment of hyperplastic polyps were included. Both the endoscopy reports and pathology reports were analyzed for ESD procedures looking at documented complications, polyp size, and enbloc removal. DISCUSSION: In total, 188 underwent ESD during the time frame studied, and 9 patients met inclusion criteria. In total, 12 ESD procedures were found. On average, each patient underwent 1.6 endoscopies prior to ESD, and 4.9 total for treatment of hyperplastic polyps. When removed by ESD, the average polyp size was 37 mm (range: 15 – 80 mm), and 63.6% were able to be removed enbloc. All polyps were located in the antrum. During ESD, there was intra-procedure bleeding during 83.3% of cases. This was controlled with clips, APC, and overstitching. No patients required hospitalization or emergent surgery. Of the 12 ESD procedures documenting successful polypectomy, 8 had follow up endoscopies within 12 months, with 100% recurrence of hyperplastic polyps. The remaining 4 are awaiting or lost to follow-up. Hyperplastic polyps involving the gastric antrum need removal due to cancer risk and often blood loss. Those resistant to standard resection can be effectively removed by ESD. Although ESD safely and successfully removed polyps, our patient population with follow up suffered a 100% recurrence rate of polyps despite good margins. Thus ESD, while safe, is not successful preventing recurrence. The pathological basis for this recurrence is unclear. We conclude that large gastric polyps recur almost always even after successful removal of by ESD.