Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2016; 22(40): 8883-8891
Published online Oct 28, 2016. doi: 10.3748/wjg.v22.i40.8883
Pathophysiological and clinical aspects of gastric hyperplastic polyps
Adam Roman Markowski, Agnieszka Markowska, Katarzyna Guzinska-Ustymowicz
Adam Roman Markowski, Department of Internal Medicine and Gastroenterology, Polish Red Cross Memorial Municipal Hospital, 15-003 Bialystok, Poland
Agnieszka Markowska, Department of Organic Chemistry, Medical University of Bialystok, 15-222 Bialystok, Poland
Katarzyna Guzinska-Ustymowicz, Department of General Pathomorphology, Medical University of Bialystok, 15-889 Bialystok, Poland
Author contributions: Markowski AR collected the information from published literature and wrote the paper; Markowska A collected the information from published literature and edited the manuscript; Guzinska-Ustymowicz K corrected the manuscript and designed the research.
Conflict-of-interest statement: There is no conflict of interest among the authors of this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Katarzyna Guzinska-Ustymowicz, MD, PhD, Assistant Professor, Department of General Pathomorphology, Medical University of Bialystok, ul. Waszyngtona 13, 15-889 Bialystok, Poland.
Telephone: +48-85-7485942 Fax: +48-85-7485996
Received: May 28, 2016
Peer-review started: May 30, 2016
First decision: July 13, 2016
Revised: August 11, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: October 28, 2016

Gastric polyps become a major clinical problem because of high prevalence and tendency to malignant transformation of some of them. The development of gastric hyperplastic polyps results from excessive proliferation of foveolar cells accompanied by their increased exfoliation, and they are macroscopically indistinguishable from other polyps with lower or higher malignant potential. Panendoscopy allows detection and differentiation of gastric polyps, usually after obtaining histopathological biopsy specimens. Unremoved gastric hyperplastic polyps may enlarge and sometimes spontaneously undergo a sequential progression to cancer. For this reason, gastric hyperplastic polyps larger than 5 mm in size should be removed in one piece. After excision of polyps with atypical focal lesion, endoscopic surveillance is suggested depending on histopathological diagnosis and possibility of confirming the completeness of endoscopic resection. Because of the risk of cancer development also in gastric mucosa outside the polyp, neighboring fragments of gastric mucosa should undergo microscopic investigations. This procedure allows for identification of patients who can benefit most from oncological endoscopic surveillance. If Helicobacter pylori (H. pylori) infection of the gastric mucosa is confirmed, treatment strategies should include eradication of bacteria, which may prevent progression of intestinal metaplasia. The efficacy of H. pylori eradication should be checked 3-6 mo later.

Keywords: Gastric hyperplastic polyp, Pathophysiology, Gastric cancer, Surveillance

Core tip: The present review is one of only a few papers describing the clinical problem of gastric hyperplastic polyps and their tendency to malignant transformation. For this reason, gastric hyperplastic polyps larger than 5 mm in size should be removed, preferably in one piece. After excision of polyps with dysplasia, careful endoscopic surveillance is needed, both places after polypectomy and surrounding mucosa.