AGA Clinical Practice Update on Management of Gastric Polyps: Expert Review

Area of Science:

• Gastroenterology
• Endoscopy
• Gastrointestinal Pathology

Background:

• Gastric polyps are common findings during upper endoscopy, encompassing diverse histologic subtypes like fundic gland polyps (FGPs) and gastric adenomas (GAs).
• Current clinical guidance for managing gastric polyps is limited, necessitating expert consensus for best practices.
• Gastric polyps often arise from underlying altered gastric mucosa, such as intestinal metaplasia and atrophic gastritis, requiring comprehensive assessment.

Purpose of the Study:

• To provide clinicians with expert advice on the diagnosis and management of gastric mucosal polyps.
• To establish a framework for understanding the natural history, epidemiology, and endoscopic features of gastric polyps.
• To guide best practices for endoscopic detection, classification, resection, and surveillance of gastric polyps and associated mucosal pathologies.

Main Methods:

• This Clinical Practice Update (CPU) is an expert review based on literature review and expert opinion.
• It provides Best Practice Advice (BPA) statements developed by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates Committee (CPUC).
• The review focuses on endoscopic techniques, histopathological assessment, and surveillance protocols for gastric polyps and related mucosal conditions.

Main Results:

• Gastric polyps have varied histologic subtypes, and different types can coexist in the same patient.
• Systematic endoscopic examination, including high-definition imaging and biopsies of polyps and surrounding mucosa, is crucial for diagnosis and management.
• Management strategies include H. pylori testing/treatment, endoscopic resection (traditional or advanced techniques), and surveillance tailored to polyp type and mucosal status.

Conclusions:

• Clinicians should be aware of the diverse types of gastric polyps and their association with underlying mucosal abnormalities.
• Comprehensive endoscopic evaluation and targeted biopsies are essential for accurate diagnosis and appropriate management planning.
• Surveillance strategies should be individualized based on polyp histopathology and the status of the surrounding gastric mucosa, particularly for dysplastic lesions and conditions like gastric intestinal metaplasia (GIM).