Synopsis
Classify gastric polyps accurately, assess the background mucosa and inherited context, remove lesions with meaningful neoplastic risk, and apply evidence-based surveillance to atrophy, intestinal metaplasia and dysplasia without over-scoping low-risk findings.
- The clinically useful gastric polyp assessment combines surface pattern, size, site, number, histology and background mucosa; the word polyp alone does not determine risk.
- Fundic-gland polyps are usually small, smooth and multiple in the fundus or body, often during PPI exposure, and sporadic lesions have very low malignant potential.
- Numerous fundic-gland polyps in a young person, dysplasia within one, an antral location or concomitant duodenal adenoma should prompt assessment for familial adenomatous polyposis.
Key red flags
Dysplasia reported from apparently flat random biopsies may reflect a subtle missed lesion or interpretive uncertainty and should trigger expert pathology confirmation plus prompt enhanced repeat endoscopy.
Investigation priorities
Characterise every lesion and search systematically for synchronous neoplasia.
Management branches
One or more gastric polyps or a premalignant biopsy finding is identified at endoscopy.
- Record lesion morphology, size, number and location with photographs, and use enhanced imaging to identify depression, irregular pattern or a resection boundary.
- Obtain appropriate lesion tissue while sampling antrum and body background separately when hyperplastic, adenomatous, atrophic or metaplastic disease is possible.
Key medicines
H. pylori eradication in premalignant gastric diseaseUse the current seven-day NICE and local-formulary PPI plus two-antibiotic combination, tailored to penicillin allergy, previous exposure and resistance advice, followed by a properly prepared active test of cure.
Review of long-term proton-pump inhibitor exposureContinue the lowest effective licensed PPI dose only for a current indication; do not stop abruptly or solely because ordinary fundic-gland polyps are present without considering reflux, ulcer and bleeding risk.