Synchronous Three Gastric Fundic Gland Polyps with Low-grade Dysplasia Treated with Endoscopic Mucosal Resection after Being Diagnosed to Be Tubular Adenocarcinoma Based on a Biopsy Specimen

Shibukawa, Narihiro; Wakahara, Yuhei; Ouchi, Shohei; Wakamatsu, Shuji; Kaneko, Akira

doi:10.2169/internalmedicine.2081-18

Cited by 7 publications

(7 citation statements)

References 7 publications

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“…In the present case, we selected ESD as the treatment strategy because this large semi-pedunculated polyp was suspected to be neoplastic based on endoscopic findings and the preoperative biopsy could not rule out neoplasm either. There are few reports of treatment for PPI-related gastric polyps; however, we found one report of endoscopic mucosal resection for a 10-mm FGP with low-grade dysplasia [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Large Fundic Gland Polyp Associated with Long-Term Proton Pump Inhibitor Administration Mimicking Gastric-Type Neoplasm

Ochiai

Kikuchi

Ito

et al. 2021

Case Rep Gastroenterol

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A 57-year-old man with a 10-year history of proton pump inhibitor (PPI) use presented with multiple fundic gland polyps (FGPs) including one >20 mm, whitish, semi-pedunculated polyp. Black spots and cobblestone-like mucosa were also observed in the stomach upon endoscopy; therefore, the lesion was considered to result from long-term PPI administration. Endoscopically, we diagnosed this polyp as a neoplastic lesion with gastric phenotype rather than a non-neoplastic lesion. Biopsy revealed an atypical glandular lesion that was indeterminate for neoplasia; therefore, we performed en bloc resection via endoscopic submucosal dissection (ESD) of the 22 × 22 × 10 mm-sized polyp. Histologically, the polyp was composed of hyperplastic foveolar epithelia in the upper half of the mucosa and hyperplastic fundic glands in the lower half of the mucosa, with luminal dilatation and parietal cell protrusion. The pathological diagnosis for this ESD specimen was FGP associated with PPI administration. We herein describe this rare case of a large FGP in <i>Helicobacter pylori</i>-uninfected gastric mucosa associated with long-term PPI administration, which was mimicking gastric-type neoplasm and resected by endoscopy.

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Section: Discussionmentioning

confidence: 99%

Large Fundic Gland Polyp Associated with Long-Term Proton Pump Inhibitor Administration Mimicking Gastric-Type Neoplasm

Ochiai

Kikuchi

Ito

et al. 2021

Case Rep Gastroenterol

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“…Last of all, a FGP with dysplastic surface epithelium was also identified in the oxyntic gland mucosa of the present case during the follow-up period of 5 years. Dysplastic change of the epithelium arising in FGPs is reportedly a very rare event, 17 and whether the FGP shared the same pathogenetic basis with the above oxyntic gland neoplasms is a topic of further investigation. FGPs usually arise in non-atrophic oxyntic gland mucosa, and are often associate with long-term use of PPl, 18 which reminds us here that a relationship between PPI use or acid suppression and occurrence of GA-FG has been a topic of discussion.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic Change of a Case of Gastric Oxyntic Neoplasm (Gastric Adenocarcinoma of Fundic Gland Mucosa Type) Through 5 Years With Concurrent Other Oxyntic Gland Lesions

et al. 2020

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Some gastric epithelial neoplasms show predominant chief cell differentiation (oxyntic gland neoplasms), in which the entity of “gastric adenocarcinoma of fundic gland type” was firstly designated, whereas a possible more aggressive subgroup “gastric adenocarcinoma of fundic gland mucosa type” (GA-FGM) was subsequently proposed. However, the histopathologic progression mode of these neoplasms has not been sufficiently reported. In this article, we describe a case of GA-FGM in which we could observe its progression during 5 years. The tumor was removed by endoscopic submucosal dissection 5 years after the first biopsy, which had already shown a feature of oxyntic gland neoplasm. During the follow-up period, the endoscopy revealed little change in the tumor appearance. However, the histology of endoscopic submucosal dissection showed submucosal extension with its histological progression. Besides, other oxyntic gland neoplasms of the stomach were observed metachronously or synchronously, giving an implication about a common pathogenetic basis of these lesions.

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“…While syndromic FGPs including GAPPS carry a significant risk for malignant change [105,106], sporadic FGPs are also known to progress to dysplasia in 0.3-3% [17,49,62,63], including high grade dysplasia [63] and, albeit rarely, to adenoma [63] and cancer [64][65][66][67][68]. FGPs with a background of PPI use were believed, without evidence, however, not to progress to dysplasia and cancer [45,63,[69][70][71], and intervention and surveillance were considered unnecessary, again without evidence [72,73].…”

Section: Implications On Clinical Managementmentioning

confidence: 99%

“…Unlike sporadic FGPs, which progress to dysplasia in 0.3-3% [17,49,62], including high grade dysplasia [63], and to cancer albeit rarely [64][65][66][67][68], FGPs with a background of PPI use were believed not to do so [45,62,[69][70][71], and intervention and surveillance were considered unnecessary [72,73].…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitors are not associated with fundic gland polyps – a systematic review that takes into consideration all known confounders

Lam,

Lau

2024

European Journal of Gastroenterology &Amp; Hepatology

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Sporadic fundic gland polyps (FGPs) progress, albeit rarely, to dysplasia and cancer. Two meta-analyses, including 8 and 11 studies, concluded that proton pump inhibitors (PPIs) were associated with FGPs. Intervention is considered unnecessary when FGPs have a background of PPIs use. Both meta-analyses, however, disregarded known confounders: age, sex, endoscopy indications, study design (prospective or retrospective), duration of PPI use, and H. pylori infection. Confounders are known to invalidate meta-analyses. We followed PRIXMA guidelines and searched the literature for studies on FGPs in PPI-users and PPI-nonusers. In the 22 studies searched, we compared FGPs in PPI-users (n = 6534) and PPI-nonusers (n = 41 115). Heterogeneity was significant (Cochran Q = 277.8, P < 0.0001; I 2 = 92.8%), annulling meta-analysis performed by blanket tallying. To offset the above confounders, we matched PPI-users and PPI-nonusers by (a) age and sex (n = 4300 and 29 307, respectively) and (b) their propensity scores derived from the confounders (n = 2950 and 4729, respectively). After both matching, FGPs were not significantly different between PPI-users and PPI-nonusers [odds ratio (OR) = 1.1, P = 0.3078; OR = 0.9, P = 0.3258, respectively]. Furthermore, FGP frequency did not correlate with increasing duration of PPI use (Pearson and Spearman correlation coefficients = 0.1162, 0.0386, P < 0.6064, 0.8646, respectively); it was not significantly different between any of the duration periods of observation, namely, <10, 10–20, 20–40, >40 months, nor was it significantly different between PPI-users and PPI-nonusers within each duration period (P > 0.05). We conclude that PPIs are not associated with FGPs, implying that a background history of PPI use is not a justification for nonintervention in the management of FGPs.

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Synchronous Three Gastric Fundic Gland Polyps with Low-grade Dysplasia Treated with Endoscopic Mucosal Resection after Being Diagnosed to Be Tubular Adenocarcinoma Based on a Biopsy Specimen

Cited by 7 publications

References 7 publications

Large Fundic Gland Polyp Associated with Long-Term Proton Pump Inhibitor Administration Mimicking Gastric-Type Neoplasm

Large Fundic Gland Polyp Associated with Long-Term Proton Pump Inhibitor Administration Mimicking Gastric-Type Neoplasm

Histopathologic Change of a Case of Gastric Oxyntic Neoplasm (Gastric Adenocarcinoma of Fundic Gland Mucosa Type) Through 5 Years With Concurrent Other Oxyntic Gland Lesions

Proton pump inhibitors are not associated with fundic gland polyps – a systematic review that takes into consideration all known confounders

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