• Much higher percentage of fundic polyps than in earlier studies
Caused by increased use of PPI medications
• Syndromic polyps have high association with cancer risk in stomach and other organs
e.g., familial polyposis, Peutz-Jeghers syndrome
(Left) Graphic shows a pedunculated polyp in the gastric antrum, prone to prolapse through the pylorus with peristalsis. Any type of large polyp may prolapse in this fashion, including large hyperplastic, adenomatous, and even polypoid masses arising from the submucosa, such as lipomas.
(Right) Upper GI series shows a polypoid mass in the duodenal bulb that is a prolapsed gastric antral polyp (adenoma).
(Left) Film from an upper GI series in a 57-year-old man shows multiple small, sessile polyps in the gastric body. The appearance and age of the patient are typical for hyperplastic polyps.
(Right) Film from an upper GI series of adenomatous polyps in a patient with familial polyposis shows innumerable small polyps throughout the stomach. These are somewhat larger, more numerous, and more irregular in shape than most hyperplastic polyps.
TERMINOLOGY
Definitions
• Protruding, space-occupying lesion within stomach
Encompass a broad spectrum of conditions that may originate in gastric mucosa or submucosa
IMAGING
General Features
• Best diagnostic clue
Radiolucent filling defect, ring shadow, or contour defect on barium study
• Morphology
Hyperplastic polyps: Smooth, sessile
– Fundic gland polyps: Always sessile, multiple, small
Adenomatous polyps: Usually single with lobulated or cauliflower-like surface
Hamartomas: Cluster of broad-based polyps
• Other general features
Polyps classified based on pathology
Fundic gland polyps
– Variant of hyperplastic polyps (< 1 cm)
– Have become most common type of gastric polyp
– Associated with use of proton-pump inhibitor medication
Hyperplastic polyps
– Virtually no malignant potential
– Typical: Small, multiple, sessile (< 1 cm)
Location: Fundus and body
– Atypical large: Solitary, pedunculated (2-6 cm), location in body and antrum
– Atypical giant: Polyp (6-10 cm) multilobulated mass, location in body and antrum
Adenomatous polyps
– Less common (< 20% of benign polyps); dysplastic lesions
– Increased risk of malignant change via adenoma-carcinoma sequence
in the duodenal bulb that is a prolapsed gastric antral polyp (adenoma).
in the gastric body. The appearance and age of the patient are typical for hyperplastic polyps.
