Management of gastric polyps

Eighty five percent of patients with benign gastric polyps are achlorhydric and gastric polyps occur in about 5 percent of all patients with pernicious anemia. Sessile polyps are much more likely to be malignant than submucosal lesions or polyps on a stalk. Histologic specimens taken at biopsy obtained endoscopically compared with the whole polyp surgically removed has given different results in as many as 75 percent of instances. Only biopsies with positive results, those showing true adenomatous epithelium or frank carcinomas, should be considered valid. When competent cytopathology is available saline lavage exfoliative gastric cytology yields the correct diagnosis of gastric carcinoma in more than 90 percent of instances with a false positive rate of less than 1 percent. Indications for operation in addition to a positive diagnosis of malignancy are: polyps thought to be causing abdominal pain, bleeding, polyps larger than 2 centimeters in diameter, true adenomatous polyps and enlarging lesions. Multiple polyps and sessile polyps are relative indications. At operation the entire mucosal surface of the stomach should be examined. Local excision is sufficient if frozen section shows the lesion to be benign. Gastric resection is the procedure of choice for malignant lesions and for carcinoma in situ, adenomatous polyps and multiple polyps in the antrum or fundus. Wide local excision is performed for carcinoma in situ in the cardia or high in the fundus. Fiberoptic endoscopy is very important in the diagnosis of gastric polyps and may prove useful in the treatment of a selected few lesions. (Hinshaw - Rochester, N.Y.)