Mistakes in the management of gastric polyps and how to avoid them

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Mistakes in the management of gastric polyps and how to avoid them

David G. Graham, William Waddingham

Summary

AI Generated

Gastric polyps, found incidentally in up to 6% of upper endoscopies, present management challenges for clinicians who often lack confidence in their identification, characterization, biopsy decisions, and long-term management strategies.

More than 90% of gastric polyps are asymptomatic and found incidentally at upper endoscopy, with a prevalence of up to 6%.
Fundic gland polyps are most frequently seen in the Western world due to their association with proton pump inhibitor usage.
In regions where Helicobacter pylori infection is prevalent, hyperplastic polyps and adenomas are more common and carry higher malignant potential.
Endoscopists often lack confidence in endoscopic characterization, biopsy decision-making, sampling strategies, and longer-term management of gastric polyps.
The British Society of Gastroenterology and European Society of Gastrointestinal Endoscopy provide guidelines with flowcharts for the management of gastric polyps.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Goddard AF, Badreldin R, Pritchard DM, et al. The management of gastric polyps. Gut 2010; 59: 1270–1276. [Link]

Carmack SW, Genta RM, Schuler CM, et al. The current spectrum of gastric polyps: A 1-year national study of over 120,000 patients. Am J Gastroenterol 2009; 104: 1524–1532. [Link]

el-Zimaity HM, Jackson FW and Graham DY. Fundic gland polyps developing during omeprazole therapy. Am J Gastroenterol 1997; 92: 1858–1860. [Link]

Morais DJ, Yamanaka A, Zeitune JMR, et al. Gastric polyps: A retrospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol 2007; 44: 14–17. [Link]

Banks M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut 2019; 68: 1545–1575. [Link]

Bisschops R, et al. Performance measures for upper gastrointestinal endoscopy: A European Society of Gastrointestinal Endoscopy quality improvement initiative. United Eur Gastroenterol J 2016; 4: 629–656. [Link]

Park JM, et al. Longer observation time increases proportion of neoplasms detected by esophagogastroduodenoscopy. Gastroenterology 2017; 153: 460–469.e1. [Link]

Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (6 Suppl): S3–S43.

Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570–578.

10.

Colling C, Asztalos I, Buchner AM, et al. Mo2037 Narrow-band imaging classification system for gastric polyps may reduce the need for biopsies. Gastrointest Endosc 2017; 85: AB531. [Link]

11.

Shaib YH, Rugge M, Graham DY, et al. Management of gastric polyps: An endoscopy-based approach. Clin Gastroenterol Hepatol 2013; 11: 1374–1384. [Link]

12.

Muehldorfer SM, Stolte M, Martus P, et al. Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: A prospective multicentre study. Gut 2002; 50: 465–470. [Link]

13.

Lloyd IE, et al. A clinicopathologic evaluation of incidental fundic gland polyps with dysplasia: implications for clinical management. Am J Gastroenterol 2017; 112: 1094–1102. [Link]

14.

Zea-Iriarte WL, et al. Carcinoma in gastric hyperplastic polyps. A phenotypic study. Dig Dis Sci 1996; 41; 377–386. [Link]

15.

Parikh M, Kelley B, Rendon G, et al. Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp. World J Gastrointest Oncol 2010; 2: 242. [Link]

16.

Rugge M, et al. Gastric epithelial dysplasia in the natural history of gastric cancer: A multicenter prospective follow-up study. Gastroenterology 1994; 107: 1288–1296. [Link]

17.

Sung, JK. Diagnosis and management of gastric dysplasia. Korean J Intern Med 2016; 31: 201–209. [Link]

18.

Wang L, Huang W, Du J, et al. Diagnostic yield of the light blue crest sign in gastric intestinal metaplasia: A meta-analysis. PLoS One 2014; 9: e92874. [Link]

19.

Kono S, et al. Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan. World J Gastroenterol 2015; 21: 13113–13123. [Link]

20.

Van Leerdam ME, et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877–895. [Link]

Abstract

Gastric polyps are usually asymptomatic, with more than 90% found incidentally and a prevalence of up to 6% at upper endoscopy. Fundic gland polyps (FGPs) are the gastric polyps most frequently seen in the Western world, largely due to their long-established association with proton pump inhibitor (PPI) usage. In countries where Helicobacter pylori infection is prevalent an endoscopist is more likely to encounter hyperplastic polyps and adenomas, which are known to be associated with a higher malignant potential. Gastric polyps are often regarded as the ‘poor relation’ to their colonic counterparts and as such clinicians often feel unsure how to identify, assess and appropriately manage these lesions. Endoscopists often lack confidence in the endoscopic characterisation of gastric polyps, feel unsure when to biopsy polyps and, if they are biopsying polyps, how many they should sample, and finally they are not always certain what the longer-term management is. The British Society of Gastroenterology (BSG) guidelines provide a useful flowchart and overview of the management of gastric polyps, and the discussion here is based on those guidelines, guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) and 12 years of clinical experience.

Topics

Digestive Oncology Endoscopy Stomach & H. Pylori

Citation

Waddingham W and Graham DG. Mistakes in the management of gastric polyps and how to avoid them. UEG Education 2021; 21: 14–17.

Published

2021

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Mistakes in colorectal cancer and how to avoid them

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Goddard AF, Badreldin R, Pritchard DM, et al. The management of gastric polyps. Gut 2010; 59: 1270–1276. [Link]

Carmack SW, Genta RM, Schuler CM, et al. The current spectrum of gastric polyps: A 1-year national study of over 120,000 patients. Am J Gastroenterol 2009; 104: 1524–1532. [Link]

el-Zimaity HM, Jackson FW and Graham DY. Fundic gland polyps developing during omeprazole therapy. Am J Gastroenterol 1997; 92: 1858–1860. [Link]

Morais DJ, Yamanaka A, Zeitune JMR, et al. Gastric polyps: A retrospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol 2007; 44: 14–17. [Link]

Banks M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut 2019; 68: 1545–1575. [Link]

Park JM, et al. Longer observation time increases proportion of neoplasms detected by esophagogastroduodenoscopy. Gastroenterology 2017; 153: 460–469.e1. [Link]

Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570–578.

10.

Colling C, Asztalos I, Buchner AM, et al. Mo2037 Narrow-band imaging classification system for gastric polyps may reduce the need for biopsies. Gastrointest Endosc 2017; 85: AB531. [Link]

11.

Shaib YH, Rugge M, Graham DY, et al. Management of gastric polyps: An endoscopy-based approach. Clin Gastroenterol Hepatol 2013; 11: 1374–1384. [Link]

12.

Muehldorfer SM, Stolte M, Martus P, et al. Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: A prospective multicentre study. Gut 2002; 50: 465–470. [Link]

13.

Lloyd IE, et al. A clinicopathologic evaluation of incidental fundic gland polyps with dysplasia: implications for clinical management. Am J Gastroenterol 2017; 112: 1094–1102. [Link]

14.

Zea-Iriarte WL, et al. Carcinoma in gastric hyperplastic polyps. A phenotypic study. Dig Dis Sci 1996; 41; 377–386. [Link]

15.

Parikh M, Kelley B, Rendon G, et al. Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp. World J Gastrointest Oncol 2010; 2: 242. [Link]

16.

Rugge M, et al. Gastric epithelial dysplasia in the natural history of gastric cancer: A multicenter prospective follow-up study. Gastroenterology 1994; 107: 1288–1296. [Link]

17.

Sung, JK. Diagnosis and management of gastric dysplasia. Korean J Intern Med 2016; 31: 201–209. [Link]

18.

Wang L, Huang W, Du J, et al. Diagnostic yield of the light blue crest sign in gastric intestinal metaplasia: A meta-analysis. PLoS One 2014; 9: e92874. [Link]

19.

Kono S, et al. Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan. World J Gastroenterol 2015; 21: 13113–13123. [Link]

20.

Van Leerdam ME, et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877–895. [Link]

Abstract

Colorectal cancer (CRC) is a common and deadly disease. Advances in understanding the disease have improved diagnosis, prevention, and treatment. Genetic factors play a role in some cases of CRC, and identifying hereditary disorders has helped reduce morbidity and mortality. Serrated polyps are also precursors of CRC, and colonoscopy is crucial for screening and prevention. However, colonoscopy is not perfect, and some lesions may be missed. Here we discuss common mistakes in CRC diagnosis, prevention, and treatment, and how to avoid them.

Topics

Digestive Oncology

Citation

Balaguer F and Castells A. Mistakes in colorectal cancer and how to avoid them. UEG Education 2016: 16: 7–10.

Published

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UEG Mistakes In Articles

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Mistakes in the endoscopic diagnosis and management of Barrett’s oesophagus and how to avoid them

Apostolis Papaefthymiou, Cormac Magee, Rehan Jamil Haidry

Summary

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Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Goddard AF, Badreldin R, Pritchard DM, et al. The management of gastric polyps. Gut 2010; 59: 1270–1276. [Link]

Carmack SW, Genta RM, Schuler CM, et al. The current spectrum of gastric polyps: A 1-year national study of over 120,000 patients. Am J Gastroenterol 2009; 104: 1524–1532. [Link]

el-Zimaity HM, Jackson FW and Graham DY. Fundic gland polyps developing during omeprazole therapy. Am J Gastroenterol 1997; 92: 1858–1860. [Link]

Morais DJ, Yamanaka A, Zeitune JMR, et al. Gastric polyps: A retrospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol 2007; 44: 14–17. [Link]

Banks M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut 2019; 68: 1545–1575. [Link]

Park JM, et al. Longer observation time increases proportion of neoplasms detected by esophagogastroduodenoscopy. Gastroenterology 2017; 153: 460–469.e1. [Link]

Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570–578.

10.

Colling C, Asztalos I, Buchner AM, et al. Mo2037 Narrow-band imaging classification system for gastric polyps may reduce the need for biopsies. Gastrointest Endosc 2017; 85: AB531. [Link]

11.

Shaib YH, Rugge M, Graham DY, et al. Management of gastric polyps: An endoscopy-based approach. Clin Gastroenterol Hepatol 2013; 11: 1374–1384. [Link]

12.

Muehldorfer SM, Stolte M, Martus P, et al. Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: A prospective multicentre study. Gut 2002; 50: 465–470. [Link]

13.

Lloyd IE, et al. A clinicopathologic evaluation of incidental fundic gland polyps with dysplasia: implications for clinical management. Am J Gastroenterol 2017; 112: 1094–1102. [Link]

14.

Zea-Iriarte WL, et al. Carcinoma in gastric hyperplastic polyps. A phenotypic study. Dig Dis Sci 1996; 41; 377–386. [Link]

15.

Parikh M, Kelley B, Rendon G, et al. Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp. World J Gastrointest Oncol 2010; 2: 242. [Link]

16.

Rugge M, et al. Gastric epithelial dysplasia in the natural history of gastric cancer: A multicenter prospective follow-up study. Gastroenterology 1994; 107: 1288–1296. [Link]

17.

Sung, JK. Diagnosis and management of gastric dysplasia. Korean J Intern Med 2016; 31: 201–209. [Link]

18.

Wang L, Huang W, Du J, et al. Diagnostic yield of the light blue crest sign in gastric intestinal metaplasia: A meta-analysis. PLoS One 2014; 9: e92874. [Link]

19.

Kono S, et al. Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan. World J Gastroenterol 2015; 21: 13113–13123. [Link]

20.

Van Leerdam ME, et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877–895. [Link]

Abstract

Barrett’s oesophagus is the precursor to oesophageal adenocarcinoma, which carries a poor prognosis, and it is likely that all endoscopists and gastroenterologists will encounter Barrett’s oesophagus in their clinical practice. Careful assessment and management of patients who have Barrett’s oesophagus with endoscopic surveillance and endoscopic endotherapy aim to reduce the risk of progression to invasive adenocarcinoma. Advances in endoscopic diagnosis and therapy should, therefore, help to reduce the risk of progression. As with all premalignant conditions and surveillance programmes, careful multidisciplinary management of the patient is important to reduce the risk of causing them to become unduly concerned. Here, we present some mistakes that in our experience are commonly made in the endoscopic diagnosis and management of Barrett’s oesophagus and give advice on how to avoid them.

Topics

Endoscopy Oesophagus

Citation

Haidry RJ and Magee C. Mistakes in the endoscopic diagnosis and management of Barrett’s oesophagus and how to avoid them. UEG Education 2018; 2018: 12–14.

Published

2024

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UEG Mistakes In Articles

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Mistakes in colonoscopic surveillance in IBD and how to avoid them

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Goddard AF, Badreldin R, Pritchard DM, et al. The management of gastric polyps. Gut 2010; 59: 1270–1276. [Link]

Carmack SW, Genta RM, Schuler CM, et al. The current spectrum of gastric polyps: A 1-year national study of over 120,000 patients. Am J Gastroenterol 2009; 104: 1524–1532. [Link]

el-Zimaity HM, Jackson FW and Graham DY. Fundic gland polyps developing during omeprazole therapy. Am J Gastroenterol 1997; 92: 1858–1860. [Link]

Morais DJ, Yamanaka A, Zeitune JMR, et al. Gastric polyps: A retrospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol 2007; 44: 14–17. [Link]

Banks M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut 2019; 68: 1545–1575. [Link]

Park JM, et al. Longer observation time increases proportion of neoplasms detected by esophagogastroduodenoscopy. Gastroenterology 2017; 153: 460–469.e1. [Link]

Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570–578.

10.

Colling C, Asztalos I, Buchner AM, et al. Mo2037 Narrow-band imaging classification system for gastric polyps may reduce the need for biopsies. Gastrointest Endosc 2017; 85: AB531. [Link]

11.

Shaib YH, Rugge M, Graham DY, et al. Management of gastric polyps: An endoscopy-based approach. Clin Gastroenterol Hepatol 2013; 11: 1374–1384. [Link]

12.

Muehldorfer SM, Stolte M, Martus P, et al. Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: A prospective multicentre study. Gut 2002; 50: 465–470. [Link]

13.

Lloyd IE, et al. A clinicopathologic evaluation of incidental fundic gland polyps with dysplasia: implications for clinical management. Am J Gastroenterol 2017; 112: 1094–1102. [Link]

14.

Zea-Iriarte WL, et al. Carcinoma in gastric hyperplastic polyps. A phenotypic study. Dig Dis Sci 1996; 41; 377–386. [Link]

15.

Parikh M, Kelley B, Rendon G, et al. Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp. World J Gastrointest Oncol 2010; 2: 242. [Link]

16.

Rugge M, et al. Gastric epithelial dysplasia in the natural history of gastric cancer: A multicenter prospective follow-up study. Gastroenterology 1994; 107: 1288–1296. [Link]

17.

Sung, JK. Diagnosis and management of gastric dysplasia. Korean J Intern Med 2016; 31: 201–209. [Link]

18.

Wang L, Huang W, Du J, et al. Diagnostic yield of the light blue crest sign in gastric intestinal metaplasia: A meta-analysis. PLoS One 2014; 9: e92874. [Link]

19.

Kono S, et al. Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan. World J Gastroenterol 2015; 21: 13113–13123. [Link]

20.

Van Leerdam ME, et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877–895. [Link]

Abstract

The diagnosis and management of colorectal cancer in patients who have inflammatory bowel disease is fraught with challenges and the subject is not without controversy. Optimal management requires a thorough knowledge of both diseases as well as the benefits and limitations of colonoscopic surveillance, careful IBD control, high-quality colonoscopy, robust surveillance booking mechanisms, empathic patient education and excellent communication across the multidisciplinary team looking after the patient. Make a mistake and your patient might be subjected to unnecessary life-changing surgery or exposed to an avoidably high lifetime risk of cancer. Here I discuss the mistakes that are often made when managing patients undergoing colitis surveillance. The discussion is evidence based, but where evidence is lacking, the discussion is based on my personal experience of more than 20 years in the field.

Topics

Digestive Oncology Endoscopy IBD

Citation

Rutter MD. Mistakes in colonoscopic surveillance in IBD and how to avoid them. UEG Education 2021; 21: 26–28

Published

2021

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Tom Welbank

UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Mistakes in gastrostomy insertion and how to avoid them

Tom Welbank

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Goddard AF, Badreldin R, Pritchard DM, et al. The management of gastric polyps. Gut 2010; 59: 1270–1276. [Link]

Carmack SW, Genta RM, Schuler CM, et al. The current spectrum of gastric polyps: A 1-year national study of over 120,000 patients. Am J Gastroenterol 2009; 104: 1524–1532. [Link]

el-Zimaity HM, Jackson FW and Graham DY. Fundic gland polyps developing during omeprazole therapy. Am J Gastroenterol 1997; 92: 1858–1860. [Link]

Morais DJ, Yamanaka A, Zeitune JMR, et al. Gastric polyps: A retrospective analysis of 26,000 digestive endoscopies. Arq Gastroenterol 2007; 44: 14–17. [Link]

Banks M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut 2019; 68: 1545–1575. [Link]

Park JM, et al. Longer observation time increases proportion of neoplasms detected by esophagogastroduodenoscopy. Gastroenterology 2017; 153: 460–469.e1. [Link]

Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570–578.

10.

Colling C, Asztalos I, Buchner AM, et al. Mo2037 Narrow-band imaging classification system for gastric polyps may reduce the need for biopsies. Gastrointest Endosc 2017; 85: AB531. [Link]

11.

Shaib YH, Rugge M, Graham DY, et al. Management of gastric polyps: An endoscopy-based approach. Clin Gastroenterol Hepatol 2013; 11: 1374–1384. [Link]

12.

Muehldorfer SM, Stolte M, Martus P, et al. Diagnostic accuracy of forceps biopsy versus polypectomy for gastric polyps: A prospective multicentre study. Gut 2002; 50: 465–470. [Link]

13.

Lloyd IE, et al. A clinicopathologic evaluation of incidental fundic gland polyps with dysplasia: implications for clinical management. Am J Gastroenterol 2017; 112: 1094–1102. [Link]

14.

Zea-Iriarte WL, et al. Carcinoma in gastric hyperplastic polyps. A phenotypic study. Dig Dis Sci 1996; 41; 377–386. [Link]

15.

Parikh M, Kelley B, Rendon G, et al. Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp. World J Gastrointest Oncol 2010; 2: 242. [Link]

16.

Rugge M, et al. Gastric epithelial dysplasia in the natural history of gastric cancer: A multicenter prospective follow-up study. Gastroenterology 1994; 107: 1288–1296. [Link]

17.

Sung, JK. Diagnosis and management of gastric dysplasia. Korean J Intern Med 2016; 31: 201–209. [Link]

18.

Wang L, Huang W, Du J, et al. Diagnostic yield of the light blue crest sign in gastric intestinal metaplasia: A meta-analysis. PLoS One 2014; 9: e92874. [Link]

19.

Kono S, et al. Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan. World J Gastroenterol 2015; 21: 13113–13123. [Link]

20.

Van Leerdam ME, et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877–895. [Link]

Abstract

Long-term enteral nutrition via gastrostomy is a relatively common medical intervention for patients at risk of malnutrition who have an accessible and functioning gastrointestinal tract. There are clear clinical guidelines describing the principles of practice as well as numerous retrospective and non-randomised controlled studies and case series. However, fewer publications impart advice and guidance regarding the management and ‘patient selection’ for these interventions. The following article provides a combination of the author’s views and the evidence base.

Topics

Small Intestine & Nutrition Stomach & H. Pylori

Citation

Welbank T, Mistakes in gastrostomy insertion ingestion and how to avoid them. UEG Education 2024; 24: 8-11.

Published

2024

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