112
Endoscopic follow-up of gastric polyps Hiroshi Mizuno, MD Seibi Kobayashi, MD Tatsuzo Kasugai, MD Nagoya, Japan
The authors describe protracted observation of gastric polyps in 118 cases. Only 4 instances of eventual adenocarcinoma, suspected of being malignant change, were found. In 7 cases polyps increased in size, while in 4 cases polyps diminished. A majority of gastric polyps remained static. Recent refinements in endoscopy have made it easier to observe gastric polyps over a long period of time. Longitudinal clinical evaluation of gastric polyps is now possible in addition to the usual histopathological examination. The course and the malignant changes in a series of 118 patients with gastric polyps were studied from the standpoint of morphologic change as seen at endoscopy. MATERIALS AND RESULTS Among 55,000 gastric examinations at Aichi Cancer Center Hospital during 6 V2 years (1966-1972), 1127 patients with gastric polyps were found. Of these 1127 cases, 118 were followed endoscopically from 1 year to 6 % years (a mean of 34.2 months). Of these 118 cases regarded as originally benign, 114 remained benign, while the remaining 4 showed malignancy in the final histologic examination. The cases which we have dealt with are those considered as benign polypoid proliferation of the gastric epithelium, excluding those considered as "epithelial atypism" by biopsy. Endoscopic findings in the benign group (114 cases): Sixty-one patients were male, and 53 were female; the ages ranged from 27 to 70 years with an average of 54.2 years; 49 patients (43%) were in their fifties (Figure 1). The types of polyps according to Yamada's c1assification 13 are listed in Table I. The endoscopic findings of size and appearance are listed in Table II.
Comparison between the cases observed over periods of less than 2 years and over periods of 2 yearsor longer indicates that the rate of morphological change increases as the period of observation becomes longer. As an example, a sessi Ie polyp was seen on the greater curvature of the antrum of a 53-year-old woman; 4 Y2 years later, the polyp increased in size with stalk formation (Figure 2). No. OF
PATl ENTS _MALE
L]
30
FEMALE
25
20
15
10 -
5
Figure 1. Distribution of 114 patients with benign gastric polyps according to age and sex.
From the Department of Internal Medicine, Aichi Cancer Center Hospital, Nagoya, Japan. Reprint requests: Hiroshi Mizuno, MD, Aichi Cancer Center Hospital, Tashiro-cho, Chikusa-ku, Nagoya 464, Japan. GASTROINTESTINAL ENDOSCOPY
113
Table I
SIZE
Gastric polyps according to Yamada's c1assification 13 and period of follow-up.
I
J[
~
TYPE
1-2
2-3
ill
3 -4
4-5
5-6
6-7
I
6
4
4
7
3
0
I
17
10
11
7
2
1
•
3
3
4
2
1
1
IV
8
TOTAL (%)
8
34 25 (29.8) (21.7)
3
7
1
19 26 (22.8) (l6.7)
7 (6.1)
1 3 (2.6)
TOTAL
24 ( 21.1) 48 (42.1) 14
Endoscopic follow-up of gastric polyps Hiroshi Mizuno, MD Seibi Kobayashi, MD Tatsuzo Kasugai, MD Nagoya, Japan
The authors describe protracted observation of gastric polyps in 118 cases. Only 4 instances of eventual adenocarcinoma, suspected of being malignant change, were found. In 7 cases polyps increased in size, while in 4 cases polyps diminished. A majority of gastric polyps remained static. Recent refinements in endoscopy have made it easier to observe gastric polyps over a long period of time. Longitudinal clinical evaluation of gastric polyps is now possible in addition to the usual histopathological examination. The course and the malignant changes in a series of 118 patients with gastric polyps were studied from the standpoint of morphologic change as seen at endoscopy. MATERIALS AND RESULTS Among 55,000 gastric examinations at Aichi Cancer Center Hospital during 6 V2 years (1966-1972), 1127 patients with gastric polyps were found. Of these 1127 cases, 118 were followed endoscopically from 1 year to 6 % years (a mean of 34.2 months). Of these 118 cases regarded as originally benign, 114 remained benign, while the remaining 4 showed malignancy in the final histologic examination. The cases which we have dealt with are those considered as benign polypoid proliferation of the gastric epithelium, excluding those considered as "epithelial atypism" by biopsy. Endoscopic findings in the benign group (114 cases): Sixty-one patients were male, and 53 were female; the ages ranged from 27 to 70 years with an average of 54.2 years; 49 patients (43%) were in their fifties (Figure 1). The types of polyps according to Yamada's c1assification 13 are listed in Table I. The endoscopic findings of size and appearance are listed in Table II.
Comparison between the cases observed over periods of less than 2 years and over periods of 2 yearsor longer indicates that the rate of morphological change increases as the period of observation becomes longer. As an example, a sessi Ie polyp was seen on the greater curvature of the antrum of a 53-year-old woman; 4 Y2 years later, the polyp increased in size with stalk formation (Figure 2). No. OF
PATl ENTS _MALE
L]
30
FEMALE
25
20
15
10 -
5
Figure 1. Distribution of 114 patients with benign gastric polyps according to age and sex.
From the Department of Internal Medicine, Aichi Cancer Center Hospital, Nagoya, Japan. Reprint requests: Hiroshi Mizuno, MD, Aichi Cancer Center Hospital, Tashiro-cho, Chikusa-ku, Nagoya 464, Japan. GASTROINTESTINAL ENDOSCOPY
113
Table I
SIZE
Gastric polyps according to Yamada's c1assification 13 and period of follow-up.
I
J[
~
TYPE
1-2
2-3
ill
3 -4
4-5
5-6
6-7
I
6
4
4
7
3
0
I
17
10
11
7
2
1
•
3
3
4
2
1
1
IV
8
TOTAL (%)
8
34 25 (29.8) (21.7)
3
7
1
19 26 (22.8) (l6.7)
7 (6.1)
1 3 (2.6)
TOTAL
24 ( 21.1) 48 (42.1) 14
