Clin Gastroenterol Hepatol
Gastric polyps: AGA update clarifies management, surveillance, and PPI use
Clinical Takeaway: Test and treat H pylori in adenomatous or hyperplastic polyps, resect most newly detected polyps at index endoscopy when feasible, and tailor surveillance to histology and dysplasia.
The American Gastroenterological Association’s latest Clinical Practice Update highlights a more systematic, mucosa-focused approach to gastric polyps—emphasizing that management hinges as much on the surrounding gastric tissue as on the polyp itself.
A central shift is comprehensive endoscopic evaluation. Clinicians should carefully inspect the entire stomach using high-definition white light plus image-enhanced techniques, with targeted and systematic biopsies to identify Helicobacter pylori, atrophic gastritis, or intestinal metaplasia—conditions that drive cancer risk and guide follow-up. The authors stress that “systematic endoscopic examination of the polyps and the surrounding gastric mucosa is essential” for appropriate management.
All patients with adenomatous or hyperplastic polyps should be tested for H pylori and treated if positive, given evidence that eradication can reduce or even eliminate hyperplastic polyps. At the same time, clinicians are advised not to discontinue proton pump inhibitors (PPIs) when there is a valid indication, even if fundic gland polyps are present—though deprescribing should be considered when no clear indication exists.
On treatment, the update leans toward more definitive upfront management. Most solitary gastric polyps should be resected at the index endoscopy for both diagnosis and therapy. Technique depends on size: cold forceps or snare for ≤3 mm, cold snare or EMR* for 4–10 mm, and EMR or ESD† for larger or suspicious lesions. When multiple polyps are present, resect the largest and any atypical lesions, and sample the rest.
Surveillance is increasingly risk-stratified. Follow-up after complete resection is recommended at 1 year for low-grade dysplasia and 6 months for high-grade dysplasia. Importantly, ongoing surveillance should also be driven by background mucosal disease—particularly intestinal metaplasia or atrophic gastritis. Non-dysplastic, sporadic fundic gland polyps generally don’t require surveillance.
Overall, the update reinforces a key principle: gastric polyps are markers of broader mucosal pathology. Careful evaluation, selective resection, H pylori eradication, and tailored surveillance can reduce missed neoplasia and better align care with cancer risk.
*EMR, endoscopic mucosal resection.
†ESD, endoscopic submucosal dissection.
Source: Buchner AM, et al. (2026, April). Clin Gastroenterol Hepatol. AGA Clinical Practice Update on Management of Gastric Polyps: Expert Review