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.