Management of Non-neoplastic Gastric Lesions.

Benign gastric lesions represent various pathologic entities and management considerations. Upper endoscopy serves as the primary diagnostic modality for gastric lesions. Persistent or giant gastric ulcers represent unique subtypes of ulcers, requiring investigation of the underlying cause. Medical management remains the mainstay of treatment; however, indications for surgical intervention remain. Gastric polyps also represent diverse etiologies, and accurate diagnosis requires pertinent information and tissue samples. Neoplastic lesions often present as polypoid lesions; a high index of suspicion is required when discovered endoscopically. Malignant transformation potential varies widely between the various lesions; therefore an accurate diagnosis is imperative to determine management.

A Case of Aggravated Hyperplastic Gastric Polyps after Treatment with Long-term Proton Pump Inhibitors / 영남의대학술지

Hyperplastic gastric polyps (HPPs) are the most common type of gastric polyps. They are assumed to be caused by chronic inflammation and regenerative proliferation, although this has not been clearly investigated yet. Many studies suggested the development of fundic gland polyps and carcinoid during long-term proton pump inhibitor (PPI) therapy, but the relationship between PPIs and HPPs is still unclear. We encountered a patient who showed aggravation of HPPs after long-term use of PPIs. A 58-year-old male patient with liver cirrhosis visited our hospital because of hematemesis. We started PPI medication after confirming esophageal variceal bleeding and duodenal ulcer with blood clot in its base via emergency endoscopy. He took PPIs for three years because of an intractable duodenal ulcer. There was a marked increase in the size of the pre-existing polyps and in the development of new polyps. We presumed that the PPIs caused the aggravation of the HPPs, so we stopped their administration. After five months, the HPPs shrank and the polyps were partially degraded. More prospective studies are needed to investigate the relationship between HPPs and PPIs.

Regression of Hyperplastic Gastric Polyp after Helicobacter pylori Eradication / 대한소화기내시경학회지

BACKGROUND/AIMS: Recent studies have suggested that the eradication of Helicobacter pylori (Hp) may lead to the regression of hyperplastic polyps (HPPs) in the stomach. We evaluated the sizes of HPPs after Hp eradication and we also compared the clinical parameters between the regression and non-regression groups. METHODS: We enrolled 187 patients who had HPPs in the stomach. The polyps were measured by using biopsy forceps, and the endoscopically observed changes of the polyps were assessed by two endoscopists. RESULTS: Total regression was observed in 68 patients of the eradicated group and in 6 patients in the non-eradicated group (42.5% vs. 22.2%, respectively, p<0.05). The non regression rate was significantly higher for the non-eradicated group than that for the eradicated group (33% vs. 10%, respectively, p<0.05). Comparing between the regression and non-regression groups, the incidence of polyps that were smaller than 10 mm in size and sessile was significantly higher in the regression group. Hp eradication was the only significant predictor of regression. CONCLUSIONS: Hp eradication could be a therapeutic option for Hp positive-hyperplastic gastric polyps, and especially for those that are less than 10 mm in size and sessile.

A Case of a Gastric Hyperplastic Polyp with a Signet Ring Cell Carcinoma / 대한소화기내시경학회지

Gastric polyps can be categorized as hyperplastic or adenomatous. Hyperplastic gastric polyps account for 28~77% of gastric polyps. Adenomatous polyps are recommended for removal due to their premalignant potential. However, there is no consensus on treatment and endoscopic surveillance of hyperplastic gastric polyps. The incidence of malignant neoplasms found in hyperplastic polyps has been reported to be about 2.1%; most of the reported cases of hyperplastic gastric polyps with malignant transformation were histologically well differentiated. We report a rare case of a gastric hyperplastic polyp with a signet ring cell carcinoma, with a review of the literature.