Management of Gastric Polyps

Epidemiology, endoscopic detection, resection techniques, and surveillance intervals for FGPs, GHPs, adenomas, and G-NETs — AGA CPU 2026 Best Practice Advice.

📖 4 Sections⏱ ~35 min✅ 4-question quiz

Epidemiology & Polyp Types

Subtypes, prevalence, risk factors

Gastric Polyps: Overview

Gastric polyps are raised epithelial lesions found in 6–8% of patients undergoing upper endoscopy. In Western countries, 70–94% are either fundic gland polyps (FGPs) or gastric hyperplastic polyps (GHPs). Recent decades have seen a shift from GHPs/adenomas toward sporadic FGPs, driven by declining H. pylori prevalence and rising PPI use.

Gastric Polyp Types — Key Characteristics (AGA CPU 2026)

Polyp Type	Prevalence	Location	Associated Conditions	Malignant Potential
FGP	47–77%	Body/fundus, multiple, <1 cm, sessile	PPI use, FAP, GAPPS; normal surrounding mucosa	<1% sporadic; 25–46% FAP-associated; GAPPS: high risk
GHP (Hyperplastic)	17–55%	Antrum > body; sessile/pedunculated, <20 mm	H. pylori gastritis, autoimmune gastritis	Dysplasia ~4%; malignant transformation 0.8–10%; ↑ risk if >2 cm
Gastric Adenoma	1–10%	Antrum > body; flat/sessile, <20 mm	H. pylori or autoimmune gastritis	LGD progression 3–4%; HGD progression 5–30%
Pyloric Gland Adenoma	<3%	Body > antrum; sessile/pedunculated, 1–10 cm	Autoimmune gastritis; FAP, Lynch, juvenile polyposis	HGD in 42%; adenocarcinoma 12–47%
Oxyntic Gland Adenoma	Rare	Body; solitary, 2–20 mm (usually <10 mm)	Normal adjacent mucosa	Large polyps or mucous neck cell differentiation may progress
G-NET	Uncommon	Body > antrum; Types 1&2 multifocal; Type 3 solitary	Type 1: autoimmune gastritis; Type 2: ZES/MEN-1	Limited metastasis Types 1&2; higher rate Type 3

⚠️ H. pylori & Hyperplastic Polyps

H. pylori eradication leads to regression of GHPs in up to 79% of cases (meta-analysis of 6 studies including 3 RCTs):

After treatment: 59% reduction in GHP prevalence (95% CI, 43–75%)

After eradication: 79% reduction (95% CI, 72–86%)

💊 PPI Use & FGPs

PPIs are associated with a 1.5–2.5× increased risk of FGPs; up to 5× with ≥12 months of use. P-CABs (vonoprazan) show similar associations — VISION trial: HP prevalence rose from 3.7% to 14.7% over 3 years.

BPA 6: Patients using PPIs for valid indications do NOT need to discontinue in the presence of documented FGP-related polyps.

BPA 5 — H. pylori Testing (Critical)

All patients with adenomatous or hyperplastic gastric polyps should be tested and treated if positive for H. pylori infection. This is a foundational management step that can lead to polyp regression and reduce gastric cancer risk.

FAP Consideration

In patients NOT on PPIs, multiple FGPs at a young age (20–40 years) or in pediatric patients should prompt evaluation for familial adenomatous polyposis (FAP). Syndromic FGPs develop in over 80% of FAP patients, typically within the first 3 decades of life. FAP now has a broader phenotypic spectrum — classic massive colonic polyposis may not always be present.

Buchner AM, Huang RJ, Lauwers GY, El-Serag HB. AGA CPU on Management of Gastric Polyps. Clin Gastroenterol Hepatol. 2026;24:893–905.