This is the most comprehensive science article about gastric polyps

Take 5 minutes of your time to fully understand gastric polyps. Are they cancerous? Do you need surgery?

I. What is a gastric polyp?

The standard medical term for a gastric polyp is a limited benign elevated lesion of the gastric mucosa, which is a benign elevated lesion protruding from the surface of the gastric mucosa, often with a smooth surface.

In layman's terms, it's like a nice wart on the skin, which can be a lone wolf occupying the mountain, or 108 generals of Liangshan, or even a group of demons.

Some of them have no conscience, and some of them have lost theirs.

It varies in size, small as a small grain of rice, medium like green beans, large as peanuts, or even like walnuts.?

If there are countless polyps of varying sizes, it is gastric polyposis, which is mostly of bad birth and genetically related.

Second, long gastric polyps, to know which hole it is the goblin

Can be largely divided into the gastric fundus gland polyps, adenomatous polyps, hyperplastic polyps, special polyps of these kinds.

1, adenomatous polyps

About 10% to 25% of the gastric polyps, cancer rate is high, up to 30% to 58.3%, especially the tumor body is large (> 2cm wide base polyp), chorionic adenomas, accompanied by heterogeneous hyperplasia of the malignant rate is higher.

This guy is a potential killer, as long as there is enough time, plus do not pay attention to the details of life, one day will develop into adenocarcinoma.

Therefore, these polyps must not be tolerated, once found, kill, and regular review, as long as he showed his head, cut, as if the bandits, be sure to eliminate the roots.

2, hyperplastic polyps

Most of the gastric polyps belong to this kind, generally not cancerous, but may bring digestive symptoms; there are about 0.4% ~ 1.76% chance of cancer. This is a small medical probability and nothing to worry about.

After H. pylori is eradicated, about 40% will completely subside.

However, as a gastroenterologist, I would like to remind you that although it is generally not cancerous, if it is large (>2cm), it should be removed.

3. Gastric fundus polyps

Gastric fundus polyps, also known as Elster cysts, are sporadic and familial.

The former may be related to the long-term use of proton pump inhibitors (azoles), which is one of the signs of the absence of Helicobacter pylori infection, and the incidence of heterogeneous hyperplasia foci is less than 1%, so basically will not be cancerous.

In the latter case, atypical hyperplasia occurs in about 25-41%, and it is difficult to distinguish between the two endoscopically.

4. Specialized gastric polyps (rare)

Ermoid tumor polyp, which occurs in the gastric antrum, is often solitary and has no malignant tendency.

Ectopic polyps: mostly benign.

Familial polyposis: gastric ones are mostly found in the gastric sinus, about 5% are adenomatous; about 50-90% of patients have duodenal adenomas and adenomas of the jugular abdomen, which are mostly malignant.

Third, long gastric polyps may not feel

In fact, many people grow polyps simply do not know, because most do not have any symptoms, just in the occasional gastroscopy found.

Some may experience mild pain or discomfort in the upper abdomen, nausea, anorexia, dyspepsia, weight loss and chronic diarrhea.

If the polyp surface is eroded and ulcerated, intermittent or continuous bleeding can occur.

Larger polyps can block the pylorus or polypoid sinus mucosa slipped into the duodenum, then pyloric obstruction symptoms can occur.

Fourth, only part of the adenomatous polyps will be cancerous

Many friends found polyps, most of the nervous, I received a female patient even cried more than on the spot.

In fact, the vast majority of gastric polyps are benign and can stay with you for life. Only adenomatous polyps can become cancerous, and they are not 100%. There is no need to be nervous.

Gastric polyps are affected by many factors, such as polyp size, type, shape, number, location, degree of interepithelial degeneration, age, as well as region and ethnicity:

1. The size of the polyp

is positively correlated, i.e., the larger the polyp, the higher the rate of cancerous transformation.

The cancer rate is less than 1 percent for pedunculated polyps less than 1.0 cm in diameter;

the cancer rate is usually 10 percent for polyps 1 to 2 cm in diameter;

the cancer rate is usually 50 percent for polyps larger than 2 cm in diameter.

2, the histological type of polyps

Adenomatous polyps have a high cancer rate, with tubular adenomas having a cancer rate of 1% to 5%, choriocarcinomas having the highest cancer rate of about 10% to 60%, and mixed polyps having a cancer rate between the two.

There are also some polyps that have a high cancer rate, with the highest cancer rate of 10% to 60%.

It is also called carcinoma in situ when the polyp undergoes severe atypical hyperplasia, in which the abnormal cells are confined to the surface of the epithelium and do not invade the basement membrane of the gland.

3, the shape of polyps

The cancer rate of polyps with tips is low, while the cancer rate of polyps without tips is high. The cancer rate of polyps with smooth surface is less than 5%, about 35% of polyps are papillary, and about 50% of polyps are cauliflower-like or lobulated. If the surface of non-tip polyps is not smooth and is in the shape of a concave flower bed, it is easy to become cancerous.

4. Location of polyps

The most common location of gastric polyps is the gastric sinus, which accounts for about 65%, followed by the body of the stomach, which accounts for about 20%. In addition, it is generally believed that the cancer rate of multiple polyps is higher than that of single polyps; the older the age, the more chances of polyps occurring, the higher the cancer rate; the longer the adenoma exists, the higher the risk of cancer. The longer the adenoma has been present, the higher the risk of cancer.

5. The malignant rate of multiple polyps is higher than that of single polyps

6. Hyperplastic polyps are rarely malignant

It is also called inflammatory polyps or regenerative polyps, which belong to the prolongation of gastric glandular hyperplasia, and the arrangement of which is relatively disorganized, with large gaps between the glands, and immature cells between them, and the vast majority of which do not have atypical proliferation, and the rate of carcinoma is only about 0.4%.

So, once the gastric polyp is found, biopsy must be taken to confirm whether the polyp is adenomatous polyp or hyperplastic polyp, if it is adenomatous polyp, in principle, it needs to be excised for treatment in order to eliminate the future problems; if it is hyperplastic polyp, according to the cause of the disease, and to take corresponding measures.

V. Why do gastric polyps grow?

Although the cause of polyps is not clear, it is generally believed to be related to the following factors:

Heredity: Genetic variation is closely related to the formation of gastric polyps, the specific mechanism is not known;

Helicobacter pylori infection: Helicobacter pylori can release a variety of inflammatory mediators and cytokines, which can damage the gastric mucosa and stimulate gastric epithelial cell hyperplasia, leading to gastric polyps. After eradication, the polyp will shrink or disappear;

Bile reflux: duodenal fluid contains bile acids, pancreatic enzymes, reflux into the stomach, can damage the gastric mucosa, and cause inflammatory hyperplasia of the gastric mucosa, resulting in gastric polyps; at the same time, a large number of reflux fluid makes the gastric pH rise, making gastrin proliferation, resulting in proliferative polyps;

Acid-suppressing medications: Long-term use of acid-suppressing drugs can lead to hypergastrinemia, which can be a cause of gastric polyposis. cause hypergastrinemia, can promote gastric gland cystic expansion, the formation of gastric polyps; gastric fundus polyps are closely related to the use of the drug, some of these patients stop using acid-suppressing drugs after the gastric fundus polyps can disappear;

Smoking: may be associated with smoking will increase the rate of infection of Helicobacter pylori bacteria; on the other hand, the tobacco smoke contains a large number of carcinogenic substances can be combined with the formation of adducts of DNA, interfering with cellular replication, affecting DNA repair. On the other hand, tobacco smoke contains a large number of carcinogens that can combine with DNA to form adducts, interfere with cell replication, affect DNA repair, cause irreversible genetic changes in the gastric mucosa, and promote the formation of polyps;

Alcohol consumption: It can damage the gastric mucosa, significantly increase the incidence of chronic gastric increase in the bacterial reproduction, and promote the synthesis of nitrosamine carcinogens, which increases the risk of gastric polyps;

Certain foods: Some people believe that more meat (red meat), salted food, fried food, less vegetable food, less food, less food, less food, less food, less food, less food. It is believed that eating more meat (red meat), preserved foods, fried foods, less vegetables, hyperlipidemia, and obesity increase the risk of developing gastric polyps.

Age and gender: Older people are more likely to develop gastric polyps than younger people, and men are more likely to develop gastric polyps than women.

VI. Which polyps need treatment?

Gastric polyps are generally benign and asymptomatic and do not require treatment. Hyperplastic polyps are non-tumorigenic polyps, which do not develop malignant lesions and are treated symptomatically by internal medicine.

Adenomatous polyps, the cancer rate can be up to 30% to 58.3%, biopsy and pathology diagnosis that is surgical treatment.

Small polyps (less than 0.5 cm in diameter) can be removed by gastroscopy or by elective resection.

Pathologically confirmed adenomatous polyps with a diameter of >2 cm, broad-based, accompanied by atypical hyperplasia, must be killed and followed by regular follow-up.

Multiple polyps, you can choose a staged excision.

Familial polyps, to be combined with colonoscopy and other tests, choose the right time to timely surgery.

For pathologically confirmed polyps with high-grade intraepithelial neoplasia, suspected cancer, or already cancerous, it is recommended that endoscopic EMR or ESD, or surgical treatment, depending on the specific circumstances.

7, removal is actually very simple

1, endoscopic treatment

Transendoscopic resection is the preferred method of treatment of gastric polyps. Endoscopic treatment of polyps is easy, little damage, low cost, most of the one-time treatment, a few need to be removed in stages.

Endoscopic treatment methods:

High-frequency electrocoagulation excision method: is currently the most widely used method, the principle is to use high-frequency electric current to produce the thermal effect of tissue coagulation, necrosis, and to achieve the purpose of excision of polyps.

Microwave cauterization: It is suitable for non-tibial polyps with a diameter of less than 50 px, and can be used to remove smaller polyps with a single cauterization, while larger polyps require multiple treatments.

Laser method: mostly used in the treatment of wide or non-tipped polyps.

Nylon wire and rubber band ligation: by ligating the root of the polyp, so that its ischemic necrosis, to achieve the therapeutic purpose.

Argon ion coagulation: mainly for broad-based non-tip, diameter less than 37.5 px.

Endoscopic EMR or ESD resection is also available for larger polyps.

Endoscopic mucosal resection EMR

Endoscopic mucosal dissection ESD

2. Surgical treatment

Surgical indications are: mainly used for endoscopic can not guarantee complete resection, or has occurred invasive malignant changes.

Non-tipped or broad-based polyps larger than 50 px.

Polyps with progressive enlargement.

Adenomatous polyps with heterogeneous hyperplasia, suspected cancer, or already cancerous.

Image: Visual China

Editor: Huiting Contact: dulin666