Gastric polyps are one of the commons ailment encountered during routine upper gastrointestinal endoscopy. They are more commonly feared as cancerous lesions which becomes matter of concern to clinician as well as the patients. As they are incidentally detected most of these gastric polyps are asymptomatic. Most of these polyps are benign (non cancerous) but long-standing gastric polyps especially large in size can be suspicious of cancers.
Common risk factors for gastric polyps
- Over consumption and long term use of proton pump inhibitors.
- Smoked and salted food preparations
- Over consumption of fat and carbohydrates
- Poor drinking water
- H pylori infection causing chronic gastritis and atrophy
- Male population
Symptoms of gastric polyps
- Detected routinely
- Bleeding in large polyps
- Ulceration of polyps
- Gastric discomfort
- Large polyps causing obstruction
- In case of cancerous polyps, symptoms of spread of disease.
Investigations and Diagnosis
After they are diagnosed on endoscopy, it is common practise to obtain the biopsy of the polypoidal lesion. Further investigations are aimed to know the depth of the polyp lesion and spread of the disease. Contrast enhanced computerised tomography ( CECT abdomen) is done to know the extent of the lesion and its spread to the surrounding areas.
Endoscopic ultrasonography ( EUS) is done commonly to assess the depth of the lesion and plan accordingly for the surgery. Positron emission tomography ( PET ) scan is done in case of advanced disease to know the spread of the cancers.
Once the diagnosis is confirmed between non cancerous and cancerous polyps the further treatment is decided by your clinician, surgeon , cancer specialists or gastroenterologist.
- Endoscopic treatment– This method is preferable in small polyps usually less then 2 cm in size, superficial lesions( not very deep) , non cancerous and cancer at very early stage. The preferred procedure is Endoscopic mucosal resection ( EMR) which is very safe and effective procedure performed by the endoscopic techniques. The main advantage is it avoids the need of surgery .
- Surgical treatment- This method is eventually the method of choice in large polyps , cancer lesions and any complications of the polyps. Minimal access surgery ( laparoscopic surgery) is the preferred surgery for most of the gastric cancers with expertise. However, routine conventional open surgery is also performed commonly.
- Chemotherapy– Use of chemotherapy is based on the biopsy report of the polyps. In case with proven cancers the chemotherapy can be given before surgery also to reduce the spread of the cancer cells and decrease the size of the tumour.
Usually the spread of early gastric polyps is limited, and results after surgery are very satisfying. We also recommend strict follow up of the patients especially after endoscopic resection as they tendency to recurrence increase with size and stage of polyp.
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