Sporadic fundic gland polyps with dysplasia or carcinoma: Clinical and endoscopic characteristics

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.

Fundic gland polyps: Should my patient stop taking PPIs?

“…Case reports have described dysplasia in patients with sporadic FGPs who take a PPI, but the true risk of carcinoma in patients with PPI-associated FGPs is unclear. 14 PPI-associated FGPs have not been linked to an increased risk of malignant transformation compared with the risk in the general population. 14,15 While the risk of dysplasia increases with polyp size in FAP-associated FGPs, a study of 132 large (> 1-cm) sporadic FGPs with a median follow-up of 3.2 years reported a rate of dysplasia of 2.6 cases per 1,000-person years of follow-up and no carcinoma.…”

“…14 PPI-associated FGPs have not been linked to an increased risk of malignant transformation compared with the risk in the general population. 14,15 While the risk of dysplasia increases with polyp size in FAP-associated FGPs, a study of 132 large (> 1-cm) sporadic FGPs with a median follow-up of 3.2 years reported a rate of dysplasia of 2.6 cases per 1,000-person years of follow-up and no carcinoma. 16 This study may have been limited by its short follow-up period, as reports of cancer with sporadic FGPs do exist.…”

“…15 In the rare cases of sporadic FGPs with carcinomas, most are small polyps with a mean size of 5.4 mm, suggesting that even polyp size may not predict malignancy risk. 14…”

“…If the endoscopic appearance has atypical characteristics such as irregular surface, redness, erosion, or depression, the polyp should be resected, as these features have been associated with dysplasia and carcinoma. 14 Polypectomy is also recommended when the size is greater than 1 cm or the…”

Editorial commentary on the Indian Journal of Gastroenterology—November–December 2022

“…Sporadic fundic gland polyps (FGPs) without dysplasia ordinarily occur in the body or fundus of Helicobacter pylori-uninfected stomachs without mucosal atrophy and are histopathologically characterized by hyperplastic proliferation of oxyntic glands with distorted glandular architecture and cystically dilated glands [18]. The polyps are often small (≤ 5 mm) and exhibit a smooth lesion surface structure.…”