Writing in the latest issue of the journal, S M Muehldorfer and colleagues studied whether forceps biopsies can provide an adequate histological diagnosis of gastric polyps.
In a prospective multi-center study, a total of 194 patients who underwent forceps biopsy and complete polypectomy were examined, and any gastric polyps larger than 5 mm were removed.
Patients with fundic gland polyps and polyposis syndrome were not included.
Primary and reference pathologists later evaluated specimens, and the complication rate of gastric polypectomy was also determined.
Of the 222 polyps removed during the study, histological examination of the polypectomy specimens revealed tumor-like lesions in 77%.
These lesions comprised 10% focal foveolar hyperplasia, 59% hyperplastic polyps, 4% inflammatory fibroid polyps, and 4% other polyps.
Neoplasia was evident in 19% of all polyps, including 10% tubular adenoma, 2% tubulovillous adenoma, 1% high grade intraepithelial neoplasia, and 6% adenocarcinoma.
|Primary and reference pathologist agreed in almost 60% of cases
Upon comparison of biopsy results between primary and reference pathologists, complete agreement was found in 124 cases (56%).
In an additional 77 cases (almost 35%) the differentiation between tumor-like lesions and neoplasia was possible.
However, in six cases (just under 3%), relevant differences were identified by the reference pathologist.
The most common reason for these differences was the failure of the biopsy to reveal foci of carcinoma in hyperplastic polyps.
Bleeding was observed after polypectomy in 16 patients, in 15 of whom it was managed conservatively.
Ending their report, the authors recommend that following a thorough individualized risk-benefit analysis, all epithelial gastric polyps larger than 5 mm should be completely removed by an experienced endoscopist.