Endoscopic ultrasonographic assessment of gastric polyps and endoscopic mucosal resection

Gastric polyps refer to a heterogeneous group of epithelial- and subepithelial-based lesions that vary in histology and malignant potential. Although many gastric polyps have characteristic endoscopic appearances, their diagnosis, classification, and potential for malignant transformation are based on histologic evaluation. Therefore, all types of gastric polyps should be biopsied during the incident endoscopy. Mucosal-based polyps include fundic gland polyps, hyperplastic polyps, adenomatous polyps, and hamartomatous polyps. Inflammatory fibroid polyps may endoscopically appear similar to mucosal-based polyps but actually arise from the submucosa. Certain types of polyps are associated with genetic syndromes or potential precancerous conditions (gastric intestinal metaplasia and chronic atrophic gastritis). If dysplasia is present and the polyp is ≥2 cm or symptomatic, the polyp should be endoscopically resected with the aim of en bloc resection. There are limited data on the use of adjunctive endoscopic ultrasound (EUS) in the evaluation of mucosal-based gastric polyps, and therefore, is not routinely employed in the management of these lesions. EUS is recommended for the evaluation of gastric subepithelial lesions.