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.

Publikationsverlauf

Eingereicht: 12. September 2019

Angenommen: 21. Januar 2020

Artikel online veröffentlicht:
02. März 2020

• References

• 1 Elhanafi S, Saadi M, Lou W. et al. Gastric polyps: association with Helicobacter pylori status and the pathology of the surrounding mucosa, a cross sectional study. World J Gastrointest Endosc 2015; 7: 995-1002
• 2 Morais DJ, Yamanaka A, Zeitune JMR. et al. Gastric polyps: a retrospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol 2007; 44: 14-17
• 3 Archimandritis A, Spiliadis C, Tzivras M. et al. Gastric epithelial polyps: a retrospective endoscopic study of 12974 symptomatic patients. Ital J Gastroenterol 1996; 28: 387-390
• 4 Olmez S, Sayar S, Saritas B. et al. Evaluation of patients with gastric polyps. North Clin Istanb 2018; 5: 41-46
• 5 Carmack SW, Genta RM, Schuler CM. et al. The current spectrum of gastric polyps: a 1-year national study of over 120,000 patients. Am J Gastroenterol 2009; 104: 1524-1532
• 6 Sonnenberg A, Genta RM. Prevalence of benign gastric polyps in a large pathology database. Dig Liver Dis 2015; 47: 164-169
• 7 Abraham SC, Singh VK, Yardley JH. et al. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol 2001; 25: 500-507
• 8 De Lisi S, Peralta S, Arini A. et al. Oesophagogastroduodenoscopy in patients with cirrhosis: extending the range of detection beyond portal hypertension. Dig Liver Dis 2011; 43: 48-53
• 9 Dirschmid K, Platz-Baudin C, Stolte M. Why is the hyperplastic polyp a marker for the precancerous condition of the gastric mucosa?. Virchows Arch 2006; 448: 80-84
• 10 Joffe N, Goldman H, Antonioli D. Recurring hyperplastic gastric polyps following subtotal gastrectomy. Am J Roentgenol 1978; 130: 301-305
• 11 Jain R, Chetty R. Gastric hyperplastic polyps: a review. Dig Dis Sci 2009; 54: 1839-1846
• 12 Han A-R, Sung CO, Kim KM. et al. The clinicopathological features of gastric hyperplastic polyps with neoplastic transformations: a suggestion of indication for endoscopic polypectomy. Gut Liver 2009; 3: 271-275
• 13 Kang HM, Oh TH, Seo JY. et al. Clinical factors predicting for neoplastic transformation of gastric hyperplastic polyps. Korean J Gastroenterol 2011; 58: 184-189
• 14 Daibo M, Itabashi M, Hirota T. Malignant transformation of gastric hyperplastic polyps. Am J Gastroenterol 1987; 82: 1016-1025
• 15 Association Française de Formation Médicale Continue en Hépato-Gastro-Entérologie. Prise en charge des lésions polypoïdes gastriques par les endoscopistes. FMC-HGE 2012; [Management of gastric polypoid lesions by endoscopists]. Available from: https://www.fmcgastro.org/postu-main/archives/postu-2012-paris/textes-postu-2012-paris/prise-en-charge-des-lesions-polypoides-gastriques-par-les-endoscopistes/
• 16 Petit B, Rivory J, Lienhart I. et al. Extensive hyperplastic recurrence after complete R0 resection by endoscopic submucosal dissection of a gastric hyperplastic polyp with dysplasia. Endoscopy 2015; 47: E529-E530
• 17 Oka S, Tanaka S, Kaneko I. et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006; 64: 877-883
• 18 Min B-H, Lee JH, Kim JJ. et al. Clinical outcomes of endoscopic submucosal dissection (ESD) for treating early gastric cancer: comparison with endoscopic mucosal resection after circumferential precutting (EMR-P). Dig Liver Dis 2009; 41: 201-209
• 19 Martín DomínguezV, Díaz MéndezA, Santander C. et al. Portal hypertensive polyps, a new entity?. Rev Esp Enferm Dig 2016; 108: 279-280
• 20 Mikhaĭlusov SV, Bart BI, Siluianov SV. et al. Duodenogastric reflux and gastric pathology in the elderly patients. Eksp Klin Gastroenterol 2010; 54-59
• 21 Correa P, Houghton J. Carcinogenesis of Helicobacter pylori . Gastroenterology 2007; 133: 659-672
• 22 Correa P, Piazuelo MB. The gastric precancerous cascade. J Dig Dis 2012; 13: 2-9