Vallot Thierry
Service d' hépato-gastroentérolgie, CHU Bichat Claude Bernard, Paris.
Presse Med. 2007 Oct;36(10 Pt 2):1412-7. doi: 10.1016/j.lpm.2007.01.025. Epub 2007 May 7.
Gastric polyps exist in a wide variety of types, most often benign. Endoscopic discovery of gastric polyps necessitates biopsies - not only of the lesion but also of the antral and fundic mucosa to determine the therapeutic strategy and subsequent surveillance. Fundic gland polyps are the most frequent type; they are asymptomatic with no malignant potential. They require neither treatment nor surveillance. Hyperplastic polyps, adenomas and tumors must be totally resected. Biopsies alone are insufficient to assess the extent of malignancy of adenomas and of hyperplastic polyps more than 5 mm in diameter. These polyps are associated with an elevated frequency of precancerous alterations of the gastric mucosa and consequently by an elevated risk of synchronous or metachronous cancer. Eradication of Helicobacter pylorus may reduce the risk of metachronous gastric cancer and recurrence after resection. Carcinoid tumors of the fundus most often occur in patients with hypergastrinemia during atrophic gastritis of autoimmune origin; they are not serious. The advantages and procedures for endoscopic surveillance of patients with a precancerous condition of the gastric mucosa have not yet been clearly established in populations with a low incidence of cancer.
胃息肉有多种类型，多数为良性。内镜检查发现胃息肉后需要进行活检——不仅要对病变部位进行活检，还要对胃窦和胃底黏膜进行活检，以确定治疗策略和后续监测方案。胃底腺息肉是最常见的类型；它们无症状，无恶变潜能。既不需要治疗也不需要监测。增生性息肉、腺瘤和肿瘤必须完全切除。仅靠活检不足以评估腺瘤以及直径大于5mm的增生性息肉的恶性程度。这些息肉与胃黏膜癌前病变的发生率升高相关，因此同步或异时性癌症的风险也会升高。根除幽门螺杆菌可能会降低异时性胃癌的风险以及切除术后的复发风险。胃底类癌肿瘤最常发生于自身免疫性萎缩性胃炎伴高胃泌素血症的患者中；病情并不严重。在癌症发病率较低的人群中，对于胃黏膜癌前病变患者进行内镜监测的优势和程序尚未明确确立。
