Gastric Polyps: Questions After Two Endoscopies - Gastroenterology and Hepatology

Both gastroscopies revealed numerous gastric polyps (with an interval of one and a half years)?

Hello Dr.
Chen: I have undergone self-paid health check-ups for two consecutive years and have found polyps in my stomach.
This year, I just completed a painless (under anesthesia) examination of my stomach and entire colon.
After the examination, the nursing staff informed me that polyps were found in my stomach, and a biopsy was sent for testing.
I asked the nurse, "Were all the polyps in my stomach completely removed?" The nurse replied, "Because there are too many small polyps in your stomach (approximately 0.1-0.2 cm), it is not possible to remove them all individually.
The physician will use their professional judgment to remove some polyps for testing, and if there are no issues, you will only need to have regular follow-up examinations annually." I have the following questions:
1.
Do I need to undergo gastrointestinal endoscopy every year?
2.
If the polyps found this time were not all removed, will I definitely find more polyps during next year's examination? Additionally, I won't know if they are newly developed or the ones that were previously removed.
3.
Are stomach polyps a result of personal constitution or dietary issues, and what preventive measures can be taken?
4.
If the polyps sent for biopsy are found to be problematic, does that mean all the polyps are problematic as well? Thank you for your answers.

mei6876, 40~49 year old female. Ask Date: 2009/04/09

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, "gastric polyps" are quite common lesions in clinical practice, with approximately 2% to 3% of the general population having gastric polyps.
Most gastric polyps are asymptomatic, and many individuals discover they have them incidentally during gastroscopy.
Only a small number of patients may experience upper abdominal discomfort due to larger polyps, or may present with melena due to ulceration and bleeding from the surface of the polyps.
Even fewer patients may experience symptoms such as nausea and vomiting due to pyloric obstruction caused by large polyps, but these cases are rare in clinical practice.

Polyps are essentially growths, and any protrusion that develops on the flat gastric mucosa can be referred to as a "gastric polyp." The exact mechanisms behind the formation of gastric polyps are not well understood.
Some may be congenital, others may arise from inflammation, and some may be caused by bile irritation following partial gastric resection.
Additionally, infection with Helicobacter pylori may also be related to the development of gastric polyps, although direct evidence is still lacking.
The management of gastric polyps can often be easily resolved through endoscopic removal.
Generally, over 90% of gastric polyps are benign.
If the biopsy report indicates hyperplastic polyps or fundic gland polyps, they are considered "benign by nature," growing slowly, and regular follow-up is typically recommended.
However, if the polyps exceed 2 centimeters in size, removal is advised.
If the biopsy report indicates adenomatous polyps, they should be removed regardless of size.

Polyps smaller than 2 centimeters are usually easier for endoscopists to remove successfully, but if the polyps are too large or located in difficult-to-reach areas of the stomach, surgical intervention may be necessary for a complete solution.
The risk of malignancy increases for adenomatous polyps larger than 2 centimeters, as they may contain carcinoma in situ; therefore, any pedunculated polyp exceeding 5 mm should be considered for polypectomy.
Currently, techniques such as electrocautery or endoscopic removal have replaced traditional surgical methods, and any removed polyps should undergo thorough pathological examination.
The number of gastric polyps can vary; some individuals may have only one, while others may have several, and there are cases with hundreds of polyps.
When the number is limited, endoscopic removal is preferred.
However, if there are too many polyps, attempting to remove them all in one session may take too long for the patient to tolerate and may increase the risk of complications.
In such cases, it is advisable to first address the larger polyps and then determine further follow-up based on the pathological report results.
Wishing you good health,
Dr.
Chi-Feng Chen, Taoyuan Hospital, Department of Health

Reply Date: 2009/04/09

More Info

Understanding gastric polyps and their implications can be quite complex, especially when one has undergone multiple endoscopic examinations. Based on your inquiries, let’s break down your questions and concerns regarding gastric polyps, their management, and the need for follow-up procedures.

1. Annual Endoscopic Surveillance
Given that you have been diagnosed with gastric polyps, it is generally recommended to have regular endoscopic surveillance. The frequency of these examinations can depend on several factors, including the type of polyps found, their size, and any associated risk factors for gastric cancer. For instance, fundic gland polyps, which are often benign and associated with proton pump inhibitor (PPI) use, may not require as frequent monitoring as adenomatous polyps, which have a higher risk of malignancy. Your gastroenterologist will tailor the follow-up schedule based on the histological findings of the biopsies and your overall risk profile.

2. New vs. Existing Polyps
You are correct in your understanding that if some polyps were not removed during your last endoscopy, it is possible that new polyps could develop over time. During your next examination, the endoscopist will typically document any polyps found, noting whether they are new or previously identified. This is why it is crucial to maintain a detailed record of your endoscopic findings and any biopsies performed, as this will help your healthcare provider determine the best course of action.

3. Causes of Gastric Polyps
The development of gastric polyps can be influenced by various factors, including genetic predisposition, dietary habits, and the use of certain medications like PPIs. While some individuals may have a genetic tendency to develop polyps, lifestyle factors such as a diet high in salt and low in fruits and vegetables can also contribute. To potentially reduce the risk of developing new polyps, consider adopting a balanced diet rich in antioxidants, maintaining a healthy weight, and avoiding smoking and excessive alcohol consumption. Regular check-ups with your healthcare provider can also help monitor any changes in your gastric health.

4. Implications of Biopsy Results
When a biopsy is performed on a polyp, the results can provide critical information about its nature. If the biopsy indicates that the polyp is benign, it does not necessarily mean that all polyps in your stomach are benign; each polyp should be evaluated individually. The pathologist will assess the tissue for signs of dysplasia or malignancy, which can inform your doctor about the potential risks associated with your gastric polyps. If any polyps are found to have precancerous changes, your doctor may recommend more aggressive management or surveillance.

Conclusion
In summary, regular endoscopic surveillance is essential for monitoring gastric polyps, especially if they have been identified in previous examinations. Understanding the nature of these polyps, their potential risks, and the importance of lifestyle modifications can empower you to take an active role in your gastric health. Always discuss your concerns and follow-up plans with your gastroenterologist, as they can provide personalized recommendations based on your specific situation. Regular communication with your healthcare provider is key to managing your condition effectively.

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