BSG 胃息肉指南 2010 GUT.pdfVIP

The management of gastric polyps Andrew F Goddard,1 Rawya Badreldin,2 D Mark Pritchard,3 Marjorie M Walker,4 Bryan Warren,5 on behalf of the British Society of Gastroenterology ABSTRACT Background Gastric polyps are important as some have malignant potential. If such polyps are left untreated, gastric cancer may result. The malignant potential depends on the histological type of the polyp. The literature base is relatively weak and any recommendations made must be viewed in light of this. Definition Gastric polyps are sessile or pedunculated lesions that originate in the gastric epithelium or submucosa and protrude into the stomach lumen. Malignant potential Depending on histological type, some gastric polyps (adenomas and hyperplastic polyps) have malignant potential and are precursors of early gastric cancer. They may also indicate an increased risk of intestinal or extra-intestinal malignancy. SUMMARY OF RECOMMENDATIONS (QUALITY OF EVIDENCE, BENEFIT/HARM RATIO, STRENGTH OF RECOMMENDATION) All types of gastric polyp detected at endoscopy need to be sampled for which forceps biopsy usually suffices (moderate, net benefit, qualified) Biopsy of intervening non-polypoid gastric mucosa is recommended for all hyperplastic and adenomatous polyps (moderate, uncertain trade-offs, qualified) If Helicobacter pylori is detected in patients with hyperplastic and adenomatous polyps, it should be eradicated (moderate, net benefit, qualified) All gastric polyps with dysplastic foci and symptomatic polyps should be completely removed (moderate, net benefit, qualified) All gastric adenomatous polyps should be removed when safe to do so (high, net benefit, definitive) If adenomatous polyps are detected, an exami- nation of the whole stomach should be made for mucosal abnormalities and any such abnorma- lities should be biopsied (moderate, net benefit, definitive) Familial adenomatous polyposis should be considered as a diagnosis in young patients with numerous fundic gland po