Upper gastrointestinal tumors

No association between gastric fundic gland polyps and gastrointestinal neoplasia in a study of over 100 000 patients (Genta et al., Clin Gastroenterol Hepatol 2009 [1])

Fundic gland polyps (FGP) are known to occur with familial adenomatous polyposis coli. When they occur in a patient with no known history of familial polyposis, they are called “sporadic.” Some small European studies have reported a possible association between FGPs and colonic adenomas or even carcinomas, suggesting that every patient with sporadic FGP should undergo colonic surveillance [2]; and even we tell our trainees to biopsy at least one or the largest FGP to define a histopathologic diagnosis. Therefore, it is interesting to read this large retrospective study, designed and carried out in a diagnostic pathology center, which denies this association.

For this study, all gastric biopsies obtained from upper gastrointestinal endoscopies performed between April 1 2007 and March 31 2008 in hospitals from 36 different states, were reviewed (103 385 patients). From the same patients, all non-inflammatory or non-hamartomatous polyps or carcinomas obtained at same-day colonoscopies or metachronous colonoscopies were also reviewed (26 017 patients).

From the 103 385 patients undergoing endoscopy, only 6081 patients (5.9 %) had features of FGPs at biopsy. Remarkably, 67.8 % were detected in women. In six patients, low-grade epithelia was seen; no high-grade dysplasia or carcinoma was found. Furthermore, in none of these patients was synchronous gastric carcinoma found, nor adenomas or carcinoids.

Patient groups who had both gastroscopy and colonoscopy with biopsies were then defined. Two groups, one consisting of upper gastrointestinal endoscopies with, and one without, FGPs were then analyzed for the presence of colonic polyps and/or colonic carcinoma. For men, the rates of serrated polyps, adenomas, and neuro-endocrine tumors were no different between the group with or the group without FGPs at upper gastrointestinal endoscopy. However, the rate for colorectal carcinoma was only 0.3 % in men with FGPs at endoscopy compared with 1.4 % when no FGPs were biopsied. For women, there was no difference in the colorectal carcinoma rate in the FGP group compared with the non-FGP group (both 1.1 %). But the female FGP group did have a higher adenoma rate (42.3 %) when compared with the non-FGP group (33.8 %).

Although this study is by nature a retrospective study with limited clinical information, some conclusions and guidelines can be drawn. One, it does not seem necessary to biopsy FGPs in patients without familial polyposis, because no evidence for high-grade dysplasia or carcinoma was found. Second, for men, the presence of FGPs at upper gastrointestinal endoscopy does not warrant a colonoscopy to rule out adenomatous polyps or cancer. The higher prevalence of adenomatous polyps in the female group with FGPs could indicate the need for a screening colonoscopy. However, in the USA, screening colonoscopies at this age are undertaken anyway. Furthermore, no increase in colonic carcinoma was found. Although it is a pity that no clinical follow-up of these patient groups is available, it does seem safe to conclude that sporadic FGPs do not warrant histologic or colonoscopic follow-up.

References

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