Endoscopic Submucosal Dissection of Large Gastric Hyperplastic Polyps: Clinicopathological Study From a Single Center

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Surgical Pathology

Background:

• Gastric hyperplastic polyps (GHPs) can cause significant clinical issues, especially when large, leading to bleeding or obstruction.
• While rare, malignant transformation of GHPs has been reported, though not observed in this study.
• Understanding the behavior and optimal management of large GHPs is crucial for patient care.

Purpose of the Study:

• To evaluate the clinicopathologic characteristics of large GHPs (≥20 mm) treated with endoscopic resection.
• To compare the efficacy and recurrence rates of different endoscopic resection techniques for large GHPs.
• To identify factors influencing successful eradication and recurrence of GHPs.

Main Methods:

• Retrospective analysis of patients undergoing endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), or snare resection (SR) for large GHPs between 2013 and 2020.
• Review of clinicopathologic features, procedural details, and follow-up endoscopic findings.
• Histopathological examination of resected specimens, including margin status and presence of metaplasia or dysplasia.

Main Results:

• Thirty-seven resections were performed on ten patients using ESD (n=16), EMR (n=15), and SR (n=6).
• High recurrence rates were observed: 69.2% for ESD, 100% for EMR, and 100% for SR, with an average follow-up of 9.4 months.
• ESD demonstrated a higher success rate for complete resection, with negative deep margins in non-recurrent cases, suggesting a field effect contributing to lateral margin recurrence.

Conclusions:

• Large GHPs present a significant management challenge due to high recurrence rates following endoscopic resection.
• Endoscopic submucosal dissection (ESD) appears more effective than EMR or SR for achieving complete resection of large GHPs.
• Recurrence, particularly at lateral margins, suggests a field effect, highlighting the importance of precise margin assessment during pathology, potentially aided by intraoperative pinning and inking.