A raised or protruding structure seen on the inner surface of the stomach during a gastroscopy may be called a “gastric polyp”. Stomach polyps come in different types, and their risk of cancer differs considerably.
The first thing to know is this: finding a stomach polyp does not mean you have stomach cancer.
Most stomach polyps cause no symptoms and are found by chance during a gastroscopy done for another reason. Current upper gastrointestinal endoscopy guidance notes that more than 90% of stomach polyps are asymptomatic.
What are the most common types of stomach polyp?
Fundic gland polyps
Seen particularly in the corpus and fundus of the stomach. They are usually small, smooth-surfaced and can be numerous. They are seen more often in people taking a proton pump inhibitor (PPI) over a long period.
In sporadic, typical-looking small fundic gland polyps the risk of becoming cancer is very low. The ESGE does not even recommend routine biopsy of typical fundic gland polyps; but lesions larger than 1 cm, those in the antrum, and those that are ulcerated or atypical in appearance should be assessed differently.
Hyperplastic polyps
These are usually related to chronic inflammation of the stomach lining. They can be seen particularly alongside:
- Helicobacter pylori
- Chronic gastritis
- Atrophic gastritis
- Intestinal metaplasia
In some patients found to have H. pylori, hyperplastic polyps can be seen to shrink or disappear after the infection is treated. Large, stalked, bleeding or symptomatic hyperplastic polyps may need removing.
Adenomatous polyps (gastric adenoma)
These matter more than the others.
Gastric adenomas are pre-cancerous lesions and should be removed completely in suitable patients. And it is not only the polyp that matters: the rest of the stomach lining should also be assessed carefully for atrophy, intestinal metaplasia and other lesions.
Is a stomach polyp cancer?
Mostly not. But the risk depends on the type of polyp.
- A fundic gland polyp Is mostly of very low risk.
- A hyperplastic polyp Is mostly harmless; but dysplasia, or rarely cancer, can be found particularly in large ones.
- An adenoma Is taken more seriously because of its potential to become cancer.
So the risk of cancer cannot be determined from “there is a polyp in the stomach” alone.
Does the size of the polyp matter?
Yes. The polyp’s size, number, location, surface, whether there is ulceration and its pathological type are all weighed together.
Polyps larger than 1 cm or unusual in appearance are assessed with particular care.
Is a biopsy taken, or is the polyp removed completely?
That decision depends on the polyp’s appearance and type. Some small, typical fundic gland polyps may not even need a biopsy, while hyperplastic or adenomatous polyps may need a biopsy or complete endoscopic removal.
A biopsy being taken from a polyp does not mean it is cancer. Pathological examination helps determine the polyp’s true type and any cellular changes such as dysplasia.
Should H. pylori be looked for?
Assessing H. pylori and the rest of the stomach lining matters particularly with hyperplastic polyps.
If H. pylori is found, appropriate eradication treatment is given. Some hyperplastic polyps can regress after H. pylori treatment.
Should every stomach polyp be removed?
No. The same approach is not applied to every polyp.
Small, typical fundic gland polyps mostly do not need removing, while gastric adenomas should be removed appropriately. Large or suspicious hyperplastic polyps may also need endoscopic removal.
Is a follow-up endoscopy needed?
That depends on the type of polyp.
Typical, sporadic fundic gland polyps usually need no particular endoscopic follow-up. By contrast, patients who have had an adenoma removed may need a follow-up gastroscopy and then further follow-up at appropriate intervals. For hyperplastic polyps the decision is made according to the polyp’s pathology and any accompanying findings such as atrophic gastritis or intestinal metaplasia.
When is more careful assessment needed?
More detailed assessment is needed if there is
A large or rapidly growing polyp · an ulcerated or irregular surface · bleeding from the polyp · dysplasia on pathology · unexplained iron deficiency or anaemia · unintended weight loss · vomiting blood or black stools.
Remember
- A stomach polyp Is not on its own cancer.
- Pathology Matters a great deal in determining the type of polyp.
- H. pylori Can be related to hyperplastic polyps in particular.
- A gastric adenoma Is a pre-cancerous lesion and should be treated appropriately.
- Not every stomach polyp Has to be removed.
- Follow-up Is decided according to the polyp’s type and the findings in the rest of the stomach.
The most important message
When a stomach polyp is found at endoscopy, what really matters is not that “there is a polyp” but the polyp’s type, size, number, appearance and pathology result.
This is not enough to make a diagnosis
If your gastroscopy report says “gastric polyp”, it has to be weighed together with the pathology result where there is one.
Sources
- Prof. Ali Tüzün İnce, MD