DISCUSSION
Gastric polyps are generally asymptomatic and detected incidentally in
endoscopic procedures performed for any reason. In our study, polyps
were detected in a total of 255 patients among 9771 gastroscopy
procedures performed at the gastroenterology endoscopy unit. In the
literature, the frequency of gastric polyps has been reported to range
between 0.3% and 6% 2,3. This rate has been reported
to be 1.2% 7, 2.2% 6 and 1.86%8 in the studies conducted in different regions of
Turkey. In this study conducted in our hospital which admits patients
from Turkey’s Southeastern Anatolia Region, the frequency of gastric
polyps was found to be 2.6%. This rate is consistent with the world
data, while it is slightly higher compared to studies conducted in
Turkey.
In a study of 269 patients with polypoid lesions, the average age of the
patients was 65 and the rate of women was 61% 9. In
another study conducted by Atalay et al.7, the average
age of patients with polyps was 58.4 years and the rate of women was
67.2%. In our study, the average age of the patients was 56.8, and the
rate in women was 62.7%.
Histopathological examination reveals gastritis or normal mucosa rather
than polyp in approximately 16-37.5% of the lesions considered polyp
endoscopically 9. In our study, histopathological
examination revealed gastritis or normal mucosa in 40% of the lesions
that were endoscopically considered polyp. 95.7% of these lesions were
polypoid lesions smaller than 5 mm.
Gastric polyps can develop anywhere on gastric mucosa. Li et al.10 reported that the most common site for gastric
polyps was the antrum, and it constituted 40.7% of all gastric polyps.
In another study, it was stated that the most common localization of
polyps was the antrum, and this was followed by the corpus2. In a study conducted in China, however, it was
reported that the frequency of polyps in the antrum decreased and the
frequency of polyps in the corpus increased 11. Polyps
were also found most commonly in the corpus with a rate of 31.9% in our
study supporting this study. The corpus was followed by the cardia,
fundus and antrum, respectively, in terms of polyp frequency. We think
that the higher number of polyps in the cardia and fundus compared to
the antrum, is associated with FGPs, which are seen in the proximal part
of the stomach and tend to be multiple.
Archimandritis et al. 12 reported that most of the
polyps (61.9%) were smaller than 5 mm in their study. In another study,
97.2% of all polyps were reported to be smaller than 10 mm13. The size of the largest polyp in our study was
found to be smaller than 5 mm at a rate of 90.2%, between 6-10 mm at a
rate of 6.7% and 10 mm and above at a rate of 3.1%; these findings are
compatible with the literature.
HPs are the most common type of gastric polyps 6.
Focal inflammatory reactions and mucosal damage are blamed for the
etiology of this type, and these polyps are associated with HP infection
and atrophic gastritis 14. HPs are more common in
middle and advanced age individuals, and females and males are affected
equally 15. Their occurrence rates in the stomach
differ among studies and vary between 18.2% and 76%.13. In our study, the mean age of occurrence of HPs
was 59.2 years, the rate of occurrence was 67% in female patients, the
rate of occurrence among all gastric polyps was 40.8%, and 81.3% of
all gastric polyps were smaller than 5 mm. 8 of HPs (7.5%) were larger
than 10 mm, and the polyp size was found to be larger than 10 mm only in
hyperplastic polyps in the patients included in the study. In our study,
HP was studied in 77 cases diagnosed with HPs, and positivity was
detected in 57 cases (74%). However, the high HP positivity was not
statistically significant.
Fundic gland polyps are the most common type of gastric polyps in
developed countries, often seen in the proximal stomach16. They are typically smaller than 10 mm and
frequently multiple, though they can be single 17.
They are known to be closely related to prolonged use of proton pump
inhibitors 18. They are mostly benign and have
malignant potential in polyposis syndromes 19. The
frequency of FGPs varies between 6.1% and 77% in the literature3,7. In our study, we found this rate to be 10.7%. In
our study, all FGPs were smaller than 10 mm and 95.8% were smaller than
5 mm. There was no significant relationship between FGPs, and gender and
HP. Intestinal metaplasia was not detected in any cases with FGPs, and
this was not statistically significant. More than one polyp was present
in 70.8% of cases with FGPs, and it was statistically significant.
According to our study, the rate of FGPs is close to the lower limit of
the range observed in the literature. This may be explained with the
high HP positivity in Turkey.
Neuroendocrine tumors of the stomach are extremely rare and originate
from enterochromaphine-like cells in the gastric fundus and corpus
mucosa 20. They are common in females and at advanced
age. In a retrospective study, the frequency of neuroendocrine tumor in
patients with gastric polyps was found to be 3.5%, the mean age was
49.9 years, and the female / male ratio was 2.3/1 6.
In our study, one of the neuroendocrine tumors was detected in the
cardia and five were detected in the corpus; neuroendocrine tumors
constituted 2.4% of the cases with gastric polyps. In addition, we
found the mean age of occurrence to be 63 years, and the female / male
ratio was found to be 5/1. More than one polyp was present in 83.3% of
cases with neuroendocrine tumor and it was statistically significant.
Our data supports the literature.
The facts that our patients could not be followed up as the study was a
retrospective study, H.Pylori could not be tested in all patients who
were found to have polyps, and the study was a single-center study, were
all limiting factors.
In conclusion, we found that the most frequently detected polyps in the
stomach were hyperplastic polyps, the majority of the cases had single
polyps, most of the polyps were smaller than 5 mm, and polyps were found
most commonly in the corpus and least commonly in the antrum. Our study
is the study that included the highest number of cases with gastric
polyps conducted in Turkey’s eastern and southeastern regions, and it
completed studies conducted previously on this issue in Turkey.