S2937 Hyperplastic Gastric Polyps, “Size Matters”

Abstract

INTRODUCTION: Hyperplastic gastric polyps are common incidental finding during EGD. They are usually asymptomatic but can present with iron deficiency anemia, gastric outlet obstruction and dysplasia especially when larger than one centimeter. CASE DESCRIPTION/METHODS: A 57-year old man without significant medical history was referred for iron deficiency anemia and occasional rectal bleeding for 1 year. His physical examination was unremarkable and family history was negative for malignancy or polyposis. Colonoscopy was normal. EGD revealed numerous large pedunculated polyps, as in Figures 1 and 2. They measured approximately 2 to 4 cm and stretched across the gastric lumen with a stalactite-like appearance. Some of the polyps were erythematous with small erosions and stigmata of recent bleeding. The polyps were removed with a hot snare over several endoscopy sessions. Pathology revealed hyperplastic polyps without dysplasia and negative stain for H. pylori. DISCUSSION: Hyperplastic polyps are equally common in men and women and typically occur in the sixth and seventh decades. They are usually found in the antrum and often are multiple. Large hyperplastic polyps often become lobulated and pedunculated, and the surface epithelium typically is eroded, which may result in chronic blood loss and iron deficiency anemia. The classic association of gastric hyperplastic polyps has been with mucosal atrophy, whether caused by H pylori infection or autoimmune gastritis. However, in recent years these polyps have increasingly been found in the background of a normal or reactive gastric mucosa without evidence of current or prior H pylori infection. Between 1% and 20% of hyperplastic polyps have been reported to harbor foci of dysplasia. Mutations of the p53 gene, chromosomal aberrations, and microsatellite instability all have been detected in these polyps. The overall prevalence of carcinoma in hyperplastic polyps is less than 2%, and it is more frequent in polyps larger than 2 cm. In view of the potential cancer risk, all hyperplastic polyps larger than 1 cm should be excised completely. Additionally, random biopsies from the intervening non-polypoid mucosa should be obtained. If present, H pylori should be eradicated and an endoscopic follow-up evaluation should be scheduled between 3 and 6 months after therapy to confirm successful eradication. The best intervals for such surveillance are unclear (e.g. annual, bi-annual, or some other interval) as is the number of years for which it should be continued.Figure 1Figure 2