Gastric Lumps and Bumps: A tale of two polyps

The stomach is far less rich in polyps than is the colon. As a result, we know much less about gastric polyps than colonic polyps, and the literature tends to be much more recent and sparser. About 5 to 10% of biopsies of endoscopic gastric polyps are normal mucosa. The reasons for this include the biopsy forceps missing the lesion, an intramural lesion that is not available to endoscopic biopsy, normal mucosa that somehow turned into an endoscopic bump and finally the pathologist doesn’t know a polyp when he or she sees one. There are about 10 named gastric polyps involving the mucosa including two surface adenomas, a deep adenoma, two heterotopias, juvenile and Peutz-Jeghers polyps, polyps with no names and no literatures and finally the two that will be discussed here, fundic gland polyps and hyperplastic polyps. From a clinician’s standpoint, the main issue is whether the polyp is neoplastic, and if it is, then whether it is benign or malignant. If it is not neoplastic, then in general, there does not seem to be a great interest in polyp type, but we type it anyway. There are a few exceptions to this. It appears from our practice that there is so little interest on the part of the endoscopists in the mucosa adjacent to a polyp or in the mucosa in the rest of the stomach, that it is only biopsied infrequently.