Cheesman Antonio R, Greenwald David A, Shah Shailja C
The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, 2215 Garland Avenue, 1025-B Medical Research Building IV, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
Curr Treat Options Gastroenterol. 2017 Dec;15(4):676-690. doi: 10.1007/s11938-017-0159-6.
Purpose of review Benign epithelial gastric polyps, although typically asymptomatic, are identified incidentally on upper endoscopy in up to 23% of patients. These include fundic gland, hyperplastic, and adenomatous polyps. Their appropriate characterization is critical as some have malignant potential, may be indicative of a gastric mucosal field defect, or may be related to an underlying polyposis syndrome. This review will discuss the current management of benign epithelial gastric polyps. Recent findings Association of gastric polyps with proton pump inhibitor use, Helicobacter pylori infection, risk of malignant transformation, and association with polyposis syndromes have been the focus of recent literature. Summary All symptomatic polyps, polyps larger than 1 cm in size, and polyps later found to contain dysplasia or cancer should be completely removed. Additionally, random biopsies from the intervening non-polypoid mucosa should be obtained. Finally, identification of multiple polyps of fundic gland type and/or concomitant dysplasia should raise suspicion for an underlying polyposis syndrome and prompt appropriate workup. Surveillance is generally only indicated if there is confirmed dysplasia and/or carcinoma within the polyp itself or if preneoplastic changes are identified in the non-polypoid gastric mucosa.
综述目的 良性上皮性胃息肉通常无症状，但在高达23%的患者上消化道内镜检查中偶然发现。这些包括胃底腺息肉、增生性息肉和腺瘤性息肉。对它们进行恰当的特征描述至关重要，因为有些具有恶变潜能，可能提示胃黏膜病变范围，或可能与潜在的息肉病综合征有关。本综述将讨论良性上皮性胃息肉的当前管理方法。 最新发现 胃息肉与质子泵抑制剂使用、幽门螺杆菌感染、恶变风险以及与息肉病综合征的关联一直是近期文献的重点。 总结 所有有症状的息肉、直径大于1厘米的息肉以及后来发现含有发育异常或癌症的息肉均应完全切除。此外，应从息肉间的非息肉样黏膜获取随机活检样本。最后，发现多个胃底腺型息肉和/或伴有发育异常应怀疑存在潜在的息肉病综合征，并促使进行适当的检查。一般仅在息肉本身确诊有发育异常和/或癌变，或在非息肉样胃黏膜中发现癌前病变时才进行监测。
