Risk of neoplastic change in large gastric hyperplastic polyps and recurrence after endoscopic resection

Abstract

Background Gastric hyperplastic polyps (GHPs) have a risk of neoplastic transformation reaching 5 %. Current endoscopic resection techniques appear suboptimal with a high risk of local recurrence. This study assessed the outcomes of endoscopic resection for GHPs and identified risk factors for recurrence and neoplastic transformation. Methods This retrospective, multicenter, European study included adult patients with at least one GHP ≥ 10 mm who underwent endoscopic resection and at least one follow-up endoscopy. Patients with recurrent GHPs or hereditary gastric polyposis were excluded. All data were retrieved from the endoscopy, pathology, and hospitalization reports. Results From June 2007 to August 2018, 145 GHPs in 108 patients were included. Recurrence after endoscopic resection was 51.0 % (74 /145) in 55 patients. R0 resection or en bloc resection did not impact the risk of polyp recurrence. In multivariate analysis, cirrhosis was the only risk factor for recurrence (odds ratio [OR] 4.82, 95 % confidence interval [CI] 1.33 – 17.46; P = 0.02). Overall, 15 GHPs (10.4 %) showed neoplastic transformation, with size > 25 mm (OR 10.24, 95 %CI 2.71 – 38.69; P < 0.001) and presence of intestinal metaplasia (OR 5.93, 95 %CI 1.56 – 22.47; P = 0.01) being associated with an increased risk of neoplastic transformation in multivariate analysis. Conclusions Results confirmed the risk of recurrence and neoplastic transformation of large GHPs. The risk of neoplastic change was significantly increased for lesions > 25 mm, with a risk of high grade dysplasia appearing in polyps ≥ 50 mm. The risk of recurrence was high, particularly in cirrhosis patients, and long-term follow-up is recommended in such patients.

Large gastric hyperplastic polyps: to resect or not to resect, that is the question!

“…In this issue of Endoscopy, Forte et al discuss the potential risk factors for recurrence and neoplastic change of large GHPs in a retrospective multicenter study [9]. The study highlights several important aspects.…”

Gastric hyperplastic polyps (hyperplasiogenic polyps): a constant debate!

“…We read with interest the manuscript by Forté et al [1] and the accompanying editorial by Bapaye [2], which summarized the key unsolved issues around gastric hyperplastic polyps. The manuscript by Forté et al [1] reported the clinical outcomes of 145 gastric hyperplastic polyps in 108 patients in the context of a retrospective multicenter study.…”

“…We read with interest the manuscript by Forté et al [1] and the accompanying editorial by Bapaye [2], which summarized the key unsolved issues around gastric hyperplastic polyps. The manuscript by Forté et al [1] reported the clinical outcomes of 145 gastric hyperplastic polyps in 108 patients in the context of a retrospective multicenter study. Studies have reported marked variabilities in the detection of gastric hyperplastic polyps [1 -8]; however, the differing frequencies of gastric hyperplastic polyps, between 28 % and 75 %, are due to the authors' definitions of gastric hyperplastic polyps.…”

“…Unfortunately, gastric hyperplastic polyps are often mixed up with foveolar hyperplasia, but it has been proven that foveolar hyperplasia shows a different morphology and is not a precursor of a gastric hyperplastic polyp [3,4]. Forté et al [1] reinforced this idea of the origin of gastric hyperplastic polyps by citing references that promoted the concept that "hyperplastic wound healing" may play a role in the etiology of gastric hyperplastic polyps. It should be underlined that gastric hyperplastic polyps are not the most frequent gastric polyp.…”

“…It is also known that the status of the gastric mucosa plays a huge role in this regard [5]. Therefore, it is surprising in our opinion that Forté et al [1] aggregated cases with autoimmune gastritis into a group of 33 patients labelled as "gastric atrophy," while cases with corpus-dominant Helicobacter gastritis were included in a large group entitled "H. pylori infection." It is also known from the literature that the majority of patients develop a relapse of gastric hyperplastic polyps after polypectomy.…”