Gastric Polyps and Dysplasias
Gastric polyps can be defined as luminal lesions projecting above the mucosal surface. Gastric polyps are detected in 2–3% of upper gastrointestinal endoscopies. Gastric polyps are generally divided into nonneoplastic and neoplastic types. About 80–90% of
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Jae Young Jang
10.1 P rinciples of Endoscopic Diagnosis of Gastric Polyps
Contents rinciples of Endoscopic Diagnosis of Gastric P Polyps 10.1.1 Definitions 10.1.2 Clinical Manifestations 10.1.3 Endoscopic Features 10.1
10.2 Nonneoplastic Polyps 10.2.1 Hyperplastic Polyps 10.2.2 Fundic Gland Polyps 10.2.3 Inflammatory Fibroid Polyp 10.2.4 Xanthoma 10.2.5 Hamartomatous Polyps and Polyps Associated with Polyposis Syndrome
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10.3 Neoplastic Polyps 10.3.1 Adenoma/Dysplasia 10.3.2 Gastric Polyps and Familial Adenomatous Polyposis
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10.1.1 Definitions Gastric polyps can be defined broadly as luminal lesions projecting above the plane of the mucosal surface. It is recommended that discrete protrusions identified on radiology or endoscopy be referred to as polypoid lesions until histological diagnoses are made. Various subtypes of gastric polyps are recognized; they are generally divided into nonneoplastic and neoplastic. About 80–90% of gastric polyps are nonneoplastic. They can be divided into epithelial and nonepithelial types (Table 10.1).
10.1.2 Clinical Manifestations Gastric polyps are detected in 2–3% of upper gastrointestinal endoscopic examinations, often incidentally. They only rarely produce symptoms, such as gastrointestinal bleeding and delayed gastric emptying. Rarely, a prolapsing antral polyp may obstruct the gastric outlet.
J. Y. Jang Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2018 H. J. Chun et al. (eds.), Clinical Gastrointestinal Endoscopy, https://doi.org/10.1007/978-981-10-4995-8_10
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Table 10.1 Classification of gastric polyps Nonneoplastic polyps
Neoplastic polyps
Miscellaneous lesions
Epithelial polyp Hyperplastic polyp Fundic gland polyp Inflammatory fibroid polyp Hamartomatous polyp Cronkhite-Canada syndrome Adenoma/dysplasia Low grade High grade Carcinoma (primary or secondary) Carcinoid tumor
Nonepithelial polyp
Xanthelasma Lymphoid hyperplasia/lymphoma Mesenchymal stromal tumors Gastrointestinal tumors Smooth muscle tumors Glomus tumor Neural tumors Schwannoma/neuroma Ganglioneuromas Granular cell tumor Other rare tumors Lipoma/liposarcoma Rhabdomyosarcoma Fibrous histiocytoma Vascular Hemangioma/lymphangioma Hemangiosarcoma
10 Gastric Polyps and Dysplasias
10.1.3 Endoscopic Features They are usually small, with a diameter of less than 1–2 cm. The endoscopic appearance of gastric polyps is variable, ranging from slightly raised plaques to soft multilobulated nodules to, more rarely, broad-based or sessile lesions. In noninvasive neoplastic lesions and carcinomas with invasion of the lamina propria, called superficial lesions, flat or even depressed morphologies below the contour of the mucosa may be observed. In pedunculated polyps, the base is narrow; in se
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