We found that the most common symptoms of GPs were nausea, anemia and abdominal pain. We also found that GPs were mostly located in the abdominal anterior, and the most common type of histopathology was HP. GP incidence was 6.35% in 2645 EGD procedures. The most common type of polyp was GFP, which accounted for 77% of all polyps, while HP and Foveolar hyperplasia （FHP） accounted for 17% of all polyps. Sixteen percent of lesions defined as polyps did not have histopathological evidence of polyps or malignant histology. A previous study associated the high frequency of GFPs with long-term PPI use and low frequency of H. pylori infection . In a previous study of 3024 endoscopic procedures, the most common type of polyp was HP[13,14]. The authors concluded that this may have been due to an increase in H. pylori infection . GPs (1.4%) were reported in 36 patients, the most common type being HP, in 2657 EGD procedures . In another study of 900 EGD procedures, GPs were found in 126 (1.4%) patients. Histological examination revealed 48 patients with HPs, 17 with GFPs, six with APs, and 118 had gastritis or normal histology .
The most common type of polyp in our study was HP. The rate of H. pylori infection in China is 60–70% . In countries with high frequency of H. pylori, the most common type of polyp is HP . In a study of 3153 EGD procedures, 135 (4.3%) patients had polypoid lesions [20,21]. The average age of the patients was 65 years . Polyp types were HP (52.3%), FGP (7.6%) and AP (3.5%). In addition, the incidence of adenocarcinoma was 1.8%. Histopathological examiniation of common mucosa showed that 29.7% of patients had polyps by EGD. A total of 153 patients (0.59%) were reported in 26 000 endoscopic procedures[22,23]. Among these patients, 41.2% were female and the average age was 64 years. The frequency of the different types of polyps was 72.4% HP, 17.2% FGP was 17.2%, and 11.8% AP. Adenocarcinoma was found in patients with HP or AP. In a study by Molaei et al, HP frequency was 69.2%, FGP was 6.6%, and AP was 4.7%. The average age of the patients was 49 years and 73% were male. In 87% of cases, polyp size was < 10 mm . In a study by Fann et al, the mean age of patients was 54.7 years, 63% were female, and 37% were male . In our study, ~80% of patients diagnosed with GPs were > 50 years old. There was no relationship between age and size and number of polyps. HPs and APs are commonly present in elderly people . In our study, the incidence of GPs was 0.38%, which was lower than in most other studies. This may be due to patients who have been excluded because they had benign lesions or inappropriate polyp sampling. There have been few studies on GPs in China. In a study conducted by Gencosmanoglu et al, the incidence of GPs was 3.6%, and 48% of the polyps were HPs, 19% FHPs, and 17% FGPs. The average age of the patients was 52 years and the proportion of women was 56.4%. In 57.2% of patients, polyp size was < 5 mm . In a study by Karaman et al, 69 (0.59%) patients had a GP in 11 598 EGD procedures. Although 69% of polyps are HP, 10% are FGPs . Buyukasik et al found that 66.7% of polyps were HPs in 55 887 EGD procedures . Vatansever et al found that the incidence of GPs was 2.22%, and the highest frequency of HPs was 36.2% . In our study, the most common type of polyp was HP. However, HP frequency was higher than in other studies. In addition, FGP frequency was significantly lower than in other studies. However, in a study conducted by Demiryilmaz et al, GPs were found in 66 (1.95%) patients in 3375 EGD procedures . A total of 88 polyploid wound lesions were detected in these patients. Histopathological examination of polyps showed that HPs accounted for 80.7%, inflammatory polyps 17%, and APs 2.3% . FGP was not detected. In some studies, FGP was the most common type of polyp.
The frequency of polyps increases due to the frequency of H. pylori infection and increased use of PPIs . Many studies have shown an increase in the frequency of FGPs in patients using PPIs. This relationship can cause anxiety among doctors and patients who need to use PPIs for a long time. In a study by Jalving et al, there was no increase in FGP frequency in patients using PPIs for < 1 year . However, it has been found that long-term use of PPIs increases the risk of developing FGP fourfold. However, the risk of displacement did not increase. When subgroup analysis was performed, a significant increase in the risk of developing FGPs was observed in patients who had used PPIs for > 5 years. Patients with omeprazole and patients with other PPIs are at increased risk for developing FGPs due to long-term use of PPIs . However, no increase in FGP frequency in patients using PPIs has been observed in some other studies . A total of 30 347 H. pylori-negative patients were evaluated and FGP frequency was similar to that in 28 096 patients without PPIs and 2251 using PPIs, and PPI users had no increased risk of polyps . This may be due to short-term use of PPIs . In a study by Choudhry et al, patients with PPIs had the highest risk of developing FGPs after an average of 37 mo . Hongo et al prospectively studied the development of FGPs and HPs in patients with long-term PPI use, which was associated with an increase in GFP frequency in H. pylori-negative patients. The formation of FGPs was not related to hypergastrinemia.
However, HP development is associated with H. pylori infection and hypergastrinemia . In our study, FGPs were found in eight patients. It is known that H. pylori infection reduces FGP formation, and these polyps are common in H. pylori-negative patients . This low incidence may be related to high rates of H. pylori infection in China. However, even in countries with high H. pylori infection rates, FGP frequency may be high, but these polyp have not been observed in several studies . Frequency of FGPs is related to long-term PPI use. No increased risk of short-term use has been observed. The most common reason for EGD surgery is complaints of indigestion. The frequency of FGPs in our patients was low; probably because they had been treated with PPIs for a short time. Also, because these polyps are so small, they may be missed during EGD surgery or may be neglected due to their indistinct endoscopic appearance.
In our study, 20 (5.2%) patients had FHPs. These lesions are considered to be precursors of HPs, although it is unclear how long FHPs take to change to HPs. The lesions may be stable or may grow or shrink. However, whether they are HP precursors is still controversial. It has been shown that the basic structure and cytological criteria of FHPs and HPs can be easily distinguished by biopsy material obtained by endoscopic forceps. These lesions are not the result of HP precursors . FHPs are common lesions in research. In our study, APs were detected in eight patients. Aps have been shown to account for 2.1% of GPs . These polyps are more common in patients with stomach cancer and have high malignant potential of 6.8–55.3% . Lesion size, height of atypical hyperplasia and presence of intestinal epithelium are risk factors for malignant tumor development. Even adenomas with low displacement during long-term follow-up have malignant potential. Therefore, it is recommended to remove these lesions . In addition, IFP was detected in one patient in our study. These polyps are not always diagnosed as endoscopic biopsies because they are local . Because our case was not diagnosed by endoscopic biopsy, it was diagnosed after surgical removal .
A total of 128 patients (33.3%) underwent snare polypectomy in our study. One patient required endoscopic control of bleeding. Low rates of hemorrhage caused by endoscopic polypectomy can be treated by sclerotherapy, endoclip or endoloop procedures. No death or penetration occurred in any patient. Snare polypectomy is a safe and effective way to diagnose and treat polyps.
In conclusion, the GP frequency in our study was low (0.38%). HP polyps were the most common types of gastric polyps. Of note, as GPs may have a risk of developing adenocarcinoma or precancerous lesions, we suggest that appropriate GP resection technology ( such as biopsy forceps or mesenchymal resection) should be applied.