João Mafalda, Areia Miguel, Alves Susana, Elvas Luís, Taveira Filipe, Brito Daniel, Saraiva Sandra, Teresa Cadime Ana
Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal.
GE Port J Gastroenterol. 2021 Sep;28(5):328-335. doi: 10.1159/000514714. Epub 2021 Apr 9.
Hyperplastic polyps represent 30-93% of all gastric epithelial polyps. They are generally detected as innocuous incidental findings; however, they have a risk of neoplastic transformation and recurrence. Frequency and risk factors for neoplastic transformation and recurrence are not well established and are fields of ongoing interest. This study aims to evaluate the frequency of and identify the risk factors for recurrence and neoplastic change of gastric hyperplastic polyps (GHP).
A single-centre retrospective cohort study including consecutive patients who underwent endoscopic resection of GHP from January 2009 to June 2020. Demographic, endoscopic, and histopathologic data was retrieved from the electronic medical records.
A total of 195 patients were included (56% women; median age 67 [35-87] years). The median size of GHP was 10 (3-50) mm, 62% ( = 120) were sessile, 61% ( = 119) were located in the antrum, and 36% ( = 71) had synchronous lesions. Recurrence rate after endoscopic resection was 23% ( = 26). In multivariate analysis, antrum location was the only risk factor for recurrence (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.1-8.1). Overall, 5.1% ( = 10) GHP showed neoplastic transformation, with low-grade dysplasia in 5, high-grade dysplasia in 4, and adenocarcinoma in 1. In multivariate analysis, a size >25 mm (OR 84; 95% CI 7.4-954) and the presence of intestinal metaplasia (OR 7.6; 95% CI 1.0-55) and dysplasia (OR 86; 95% CI 10-741) in adjacent mucosa were associated with an increased risk of neoplastic transformation. Recurrence was not associated with neoplastic transformation (OR 1.1; 95% CI 0.2-5.9).
Our results confirmed the risk of recurrence and neoplastic transformation of GHP. Antrum location was a predictor of recurrence. The risk of neoplastic change was increased in large lesions and with intestinal metaplasia and dysplasia in adjacent mucosa. More frequent endoscopic surveillance may be required in these subgroups of GHP.
增生性息肉占所有胃上皮息肉的30%-93%。它们通常是在无害的偶然检查中被发现；然而，它们有发生肿瘤转化和复发的风险。肿瘤转化和复发的频率及危险因素尚未完全明确，仍是当前研究的热点领域。本研究旨在评估胃增生性息肉（GHP）复发及肿瘤变化的频率，并确定其危险因素。
一项单中心回顾性队列研究，纳入2009年1月至2020年6月期间连续接受GHP内镜切除术的患者。从电子病历中获取人口统计学、内镜及组织病理学数据。
共纳入195例患者（女性占56%；中位年龄67[35-87]岁）。GHP的中位大小为10（3-50）mm，62%（n = 120）为无蒂型，61%（n = 119）位于胃窦部，36%（n = 71）有同步病变。内镜切除术后的复发率为23%（n = 26）。多因素分析显示，胃窦部位置是复发的唯一危险因素（比值比[OR]3.0；95%置信区间[CI]1.1-8.1）。总体而言，5.1%（n = 10）的GHP发生了肿瘤转化，其中低级别异型增生5例，高级别异型增生4例，腺癌1例。多因素分析显示，息肉大小>25 mm（OR 84；95%CI 7.4-954）、相邻黏膜存在肠化生（OR 7.6；95%CI 1.0-55）和异型增生（OR 86；95%CI 10-741）与肿瘤转化风险增加相关。复发与肿瘤转化无关（OR 1.1；95%CI 0.2-5.9）。
我们的结果证实了GHP存在复发及肿瘤转化的风险。胃窦部位置是复发的预测因素。大息肉以及相邻黏膜存在肠化生和异型增生时，肿瘤变化的风险增加。对于这些GHP亚组可能需要更频繁的内镜监测。
