By: Thalia Kaylyn Averil
Gastric polyps are growths that protrude into the lining of the stomach. Most gastric polyps are not harmful, but some gastric polyps have the potential to develop into cancer if left untreated. Generally, gastric polyps do not cause any symptoms, so they are often discovered incidentally during endoscopic procedures. Gastric polyps are found in 2% to 6% of people undergoing endoscopy. Gastric polyps become more common with age and are also influenced by diet and lifestyle.
The cause of the formation of gastric polyps is still not certain, but it is thought to vary according to the type. There are various types of gastric polyps that require biopsy and microscopic examination to identify them, namely:
- Hyperplastic polyps: Hyperplastic polyps are characterized by excessive growth of surface cells. Hyperplastic polyps are thought to occur due to ongoing stomach inflammation and are often associated with atrophic gastritis and Helicobacter pylori infection. Studies show that hyperplastic polyps can shrink on their own after treatment of Helicobacter pylori infection after a few months.
- Fundic gland polyps: Fundic gland polyps involve enlarged glands in the lining of the stomach. Research shows that the occurrence of these polyps is related to long-term use of drugs that reduce stomach acid.
- Adenomatous polyps: Adenomatous polyps indicate abnormal glandular changes. In contrast, adenomatous polyps are more closely related to age or chronic inflammation and tissue irritation. This can cause abnormal cell changes, increasing the risk of cancer, which is often driven by genetic mutations that affect genes such as p53 and Ki-67.
The potential for malignancy increases as the size of the polyp grows. Therefore, proper treatment of gastric polyps has the potential to reduce the incidence of stomach cancer. Larger polyps (more than 5 mm or 10 mm in size) are highly recommended for removal. Even though polyps may not appear harmful initially, doctors still recommend removing them because polyps can grow and potentially become cancerous later on. Polypectomy is a procedure performed to remove polyps in various organs or body cavities. Polypectomy is minimally invasive because it only uses small instruments that are inserted through holes in the body.
Stomach cancer ranks third globally among cancers that can cause death, with its exact causes still not entirely clear. Stomach cancer begins with changes in the epithelial cells lining the stomach. Lifestyle, environmental factors, genetic predisposition, and a history of Helicobacter pylori infection contribute to the risk of stomach cancer. Additionally, diseases that contribute to the development of stomach cancer include conditions such as atrophic gastritis, gastric polyps, and pernicious anemia (a condition caused by vitamin B12 deficiency).
Endoscopy is the most effective method for examining the lining of the upper digestive tract. Endoscopy is performed by inserting a flexible tube through the mouth to examine the esophagus, stomach, first part of the small intestine (duodenum), etc. This procedure can be performed with local anesthesia in the throat or general anesthesia to ensure the patient is more comfortable during the procedure. In general, upper gastrointestinal endoscopy is performed for the following indications:
- Examining abnormalities found in radiological examinations more clearly
- Patients who have persistent symptoms such as vomiting, dysphagia or discomfort when swallowing food and drink, pain that occurs in the upper abdomen, and others
- Acute bleeding from the upper digestive tract
- Acute bleeding of the upper gastrointestinal tract
- Patients with complaints of upper gastrointestinal tract post gastric surgery
- Patients over 45 years of age with dyspepsia syndrome or discomfort in the upper abdomen accompanied by danger signs
- Endoscopy can also be performed as a therapeutic procedure such as insertion of a feeding tube or dilatation for a narrowed part of the digestive tract
However, repeated endoscopic examinations are also necessary in certain conditions. One of them is to monitor the healing of benign ulcers or monitor ulcers that are suspected of possibly being malignant. Routine endoscopic examinations also serve to detect early signs of cancer in the digestive tract, enabling patients to receive earlier treatment. Research also shows that routine endoscopic examinations can find abnormalities such as stomach cancer, adenomas, and others more effectively. Therefore, regular endoscopic examination plays a very important role in the early detection, treatment and prevention of gastrointestinal diseases.
Resources
- Arteaga CD, Wadhwa R. Gastric Polyp. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560704/
- Setiati S, Alwi I, Sudoyo AW, Simadibrata M, Setiyohadi B, Syam AF, editor. Buku ajar ilmu penyakit dalam. 6th ed. Jakarta: Interna Publishing; 2014.
- Nguyen VX, Le Nguyen VT, Nguyen CC. Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers. Int J Gen Med. 2010 Nov 1;3:345-57. doi: 10.2147/IJGM.S14555. PMID: 21116340; PMCID: PMC2990396. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990396/
- Cleveland Clinic. Polypectomy [Internet]. Cleveland: Cleveland Clinic; date of publication unknown [reviewed 2021 Aug 7] [cited 2024 Jul 9]. Available from: https://my.clevelandclinic.org/health/treatments/23479-polypectomy
