What are the treatment options for gastric polyps?

Hello,

Welcome to icliniq.com.

Well, I doubt if it is hyperplastic polyps that are showing dysplasia. Since hyperplastic polyps are purely benign polyps of the stomach, they do not need resection. And biopsy to be done only to confirm hyperplastic polyps. Kindly upload the endoscopic picture and histology report as I can interpret it for you. This site is another essential thing to be considered for other decisions via EMR (Endoscopic mucosal resection) or ESD (Endoscopic submucosal dissection).

Regards.

Hello,

Welcome back to icliniq.com.

I have seen the endoscopy report you have uploaded (attachment removed to protect patient identity) but again did not upload the biopsy report of it. Since it is a crucial step in decision-making, I would need to see the biopsy findings of the polyps they have taken and the extent of the dysplasia.

And need to look if they have taken a routine stomach biopsy to rule out whether there is any evidence of Helicobacter pylori infection. Since in the presence of Helicobacter pylori infections, these findings are common, and treatment of this would resolve the changes within the stomach.

On your endoscopy, I can see it is not just polyps formation, but there is significant ulceration that probably leads you to develop blood in vomiting (hematemesis). The other close differential of this hyperplastic polyps is inflammatory polyps. The inflammatory polyps are seen whenever there is inflammation of the lining of the stomach. This again sensitizes me to see your histopathological report to rule out active infection like Helicobacter pylori, which can be the cause of ulceration, bleeding, and secondarily formation of the inflammatory polyps.

I doubt if the histopathologist was able to diagnose dysplasia's presence since mild dysplasia is evident and can be present in the presence of ulceration and inflammation.

To answer your concern in the previous query, whether you need an EMR or ESD to clean it up? I think you need to be treated for ulcerations with Anti Helicobactor pylori antibiotic treatment for 14 days, followed by acid suppressant medications for another six weeks time. Then re-look endoscopy to see if these polyps shrink in size and variation in the biopsy report. Only then a more straightforward decision be taken, whether to continue with acid suppressant medications or to remove if present then, with ESD, preferably because of their current size.

I am waiting to see your histopathological report. Please upload any other investigations of blood or stool you have been done recently.

Regards.

Hi,

Welcome back to icliniq.com.

Thank you for providing me the further information regarding your case.

Well, the histopathological report suggests they are hyperplastic polyps. The Word elongated crypts (foot or paddle formation) is characteristic of the hyperplastic polyps. Well, the risk of developing cancer is almost negligible. Since your functional problem is of pain and bleeding, then they need to be removed. ESD (end-systolic dimension) is the best option. And yes, it can easily be performed safely in expert hands. EMR is not an option here. Since it is performed for small size polyps that can be removed en bloc ( as a whole), or sometimes for larger polyps like this one, but via piecemeal fashion (removing larger polyps in smaller pieces). The risk of residual polyps is high with the EMR piecemeal. So yes, the answer is ESD. It would help if you continued taking acid suppressant medications but switching from Omeprazole to Esomeprazole 40 mg a half hour before meals twice daily until we reach a definite treatment. I hope this served the purpose. And I also suggest you have a colonoscopy done since you reach up to the age of 50, and it is essential to see the colon. If already done and no findings there, then the next colonoscopy should be after five to ten years based on local screening protocols. Best regards.