GuidelineThe role of endoscopy in the management of premalignant and malignant conditions of the stomach
Section snippets
Sporadic gastric epithelial polyps
Gastric polyp histology cannot be reliably distinguished by endoscopic appearance; therefore, biopsy or polypectomy is warranted when polyps are detected.5 The majority (70%-90%) of gastric epithelial polyps are fundic gland polyps (FGPs) or hyperplastic polyps and are often incidental findings on endoscopy. Sporadic FGPs may develop in association with long-term proton pump inhibitor use and are not associated with an increased risk of cancer in the absence of familial adenomatous polyposis
Diagnosis
Adenocarcinoma, the most common form of gastric malignancy, typically presents as a mass lesion, but may present as a nonhealing gastric ulcer or as a diffuse infiltrative form known as linitis plastica. The criterion standard for diagnosing gastric cancer is endoscopic mucosal biopsy. Generally, the mass or abnormal mucosa is targeted for biopsy, although in the case of a malignant gastric ulcer, at least 7 biopsies of the heaped up edges of the ulcer and base should be performed.86 Diagnosing
Recommendations
- 1.
We recommend solitary gastric polyps undergo biopsy or be resected when possible. ⊕⊕⊕⊕
- 2.
We suggest polypectomy of fundic gland polyps 1 cm or larger, hyperplastic polyps 0.5 cm or larger, and adenomatous polyps of any size when possible. ⊕⊕○○
- 3.
We suggest surveillance endoscopy 1 year after removing adenomatous gastric polyps. ⊕⊕○○
- 4.
In the setting of multiple polyps, we recommend biopsy or resection of the largest polyps and representative biopsy specimens be taken from others. ⊕⊕⊕⊕
- 5.
In the setting of
Disclosure
Dr Pasha has received research support from CapsoVision; Dr Hwang is a consultant for US Endoscopy and a speaker for Novartis; Dr Fisher is a consultant for Epigenomics. All other authors disclosed no financial relationships relevant to this publication.
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This document is a product of the ASGE Standards of Practice Committee. This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.