New classification of gastric polyps: An in-depth analysis and critical evaluation

With the widespread use of upper gastrointestinal endoscopy, more and more gastric polyps (GPs) are being detected. Traditional management strategies often rely on histopathologic examination, which can be time-consuming and may not guide immediate clinical decisions. This paper aims to introduce a novel classification system for GPs based on their potential risk of malignant transformation, categorizing them as "good", "bad", and "ugly". A review of the literature and clinical case analysis were conducted to explore the clinical implications, management strategies, and the system's application in endoscopic practice. Good polyps, mainly including fundic gland polyps and inflammatory fibrous polyps, have a low risk of malignancy and typically require minimal or no intervention. Bad polyps, mainly including hyperplastic polyps and adenomas, pose an intermediate risk of malignancy, necessitating closer monitoring or removal. Ugly polyps, mainly including type 3 neuroendocrine tumors and early gastric cancer, indicate a high potential for malignancy and require urgent and comprehensive treatment. The new classification system provides a simplified and practical framework for diagnosing and managing GPs, improving diagnostic accuracy, guiding individualized treatment, and promoting advancements in endoscopic techniques. Despite some challenges, such as the risk of misclassification due to similar endoscopic appearances, this system is essential for the standardized management of GPs. It also lays the foundation for future research into biomarkers and the development of personalized medicine.