Ginsberg G G, Al-Kawas F H, Fleischer D E, Reilly H F, Benjamin S B
Division of Gastroenterology, Department of Medicine, Georgetown University Hospital, Washington, D.C., USA.
Am J Gastroenterol. 1996 Apr;91(4):714-7.
Management of gastric polyps based on polyp size (< or > 2 cm), and histology obtained from forceps biopsy sampling is controversial. To illuminate this subject, the 4-yr experience with endoscopic management of gastric epithelial polyps at a university hospital and a Veterans Administration medical center was reviewed with histopathologic correlation.
A computer data-base was used to recall the endoscopic diagnosis of "gastric polyp." Endoscopy reports, video, and still photography were reviewed for data on polyp appearance, size, location, and management. These data had been entered prospectively as required by the Computer-Based Management System. Histopathology was reviewed by a second, blinded, pathologist. Gastric polyps of epithelial origin, at least 0.5 cm in diameter, and not associated with polyposis syndromes, were included.
Thirty-five gastric polyps in 23 patients met inclusion criteria. Snare polypectomy was ultimately performed on 26, and complete resection with forceps biopsy alone on 9. On histopathology 31 polyps were hyperplastic and 4 were adenomas. Six hyperplastic polyps contained focal dysplasia. Among these, carcinoma in situ was identified in three, all <2.0 cm. Furthermore, forceps biopsy in two of these did not reveal the dysplastic components. One adenomatous polyp also contained carcinoma, also <2.0 cm.
These data emphasize that management based on polyp size or histology obtained from forceps biopsy sampling may be faulty. We recommend that gastric polyps >0.5 cm be removed in toto.
基于息肉大小（＜或＞2cm）以及钳取活检组织学结果来管理胃息肉存在争议。为阐明这一问题，回顾了一所大学医院和一家退伍军人管理局医疗中心4年期间对胃上皮息肉进行内镜治疗的经验，并与组织病理学结果进行相关性分析。
利用计算机数据库检索“胃息肉”的内镜诊断。查阅内镜检查报告、视频及静态照片，获取息肉外观、大小、位置及治疗相关数据。这些数据已按照基于计算机的管理系统要求前瞻性录入。由另一位不知情的病理学家复查组织病理学结果。纳入直径至少0.5cm、非息肉病综合征相关的胃上皮源性息肉。
23例患者中的35个胃息肉符合纳入标准。最终26个息肉接受圈套器息肉切除术，9个仅通过钳取活检实现完全切除。组织病理学检查显示，31个息肉为增生性，4个为腺瘤性。6个增生性息肉存在局灶性发育异常。其中3个原位癌，均＜2.0cm。此外，其中2个的钳取活检未发现发育异常成分。1个腺瘤性息肉也含有癌，同样＜2.0cm。
这些数据强调，基于息肉大小或钳取活检组织学结果进行管理可能有误。我们建议将直径＞0.5cm的胃息肉完整切除。
