Objective Recent guidelines on endoscopic sampling recommend complete gastric polyp removal for solitary fundic polyps >10 mm, hyperplastic polyps >5 mm and all adenomatous polyps. We aim to describe endoscopic approach to polyps in the time period prior to the American Society of Gastrointestinal Endoscopy (ASGE) guidelines and to identify opportunities for clinical practice improvements.
Design Retrospective review of the Clinical Outcome Research Initiative (CORI) database, including all oesophagogastroduodenoscopies (OGDs). Reviewers grouped interventions during procedures based on instruments used for polyp sampling by forceps or snare polypectomy. Logistic regression estimated the effect of variables of interest on method of polypectomy.
Results Of 783 037 OGDs reported in the CORI database, 25 670 (3.3%) described gastric polyps and met the inclusion criteria. Mean gastric polyp size was 6.5±4.9 mm, and 46.2% and 14.5% were located in the corpus and antrum, respectively. Polyps in the forceps group were smaller than polyps in the snare group (5.7±4.0 mm vs 9.3±6.4 mm, respectively, p<0.001). We identified 1056 polyps (41.3%) >10 mm that only underwent forceps biopsy. Forceps were used more frequently in the gastric fundus.
Conclusions Snare polypectomy was underused in gastric polyps, per current ASGE guidelines. Anatomical location and endoscopic features of polyps were important predictors of the approach to gastric polypectomy.
- endoscopic polypectomy
- gastric pre-cancer
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Contributors JEC and DAS: study conception and design, manuscript writing. TK and LID: analysis and interpretation of data and generation of tables and figures. DRM: literature review and interpretation of data. All authors approved the final draft of the article.
Funding DRM is supported in part by grants from the U.S. National Institutes of Health (P01 CA028842, R01 CA190612, R03 CA167773, P30 CA068485, P30 DK058404). DAS is supported in part by grants from the Center for AIDS Research (CFAR) at the University of Miami–Miller School of Medicine funded by a grant from the National Institutes of Health (P30AI073961), American Cancer Society and the Florida Department of Health.
Disclaimer This manuscript was not prepared in collaboration with the CORI group and does not necessarily reflect the opinions or views of the CORI group, the NIDDK Central Repositories or the NIDDK (Data request Id 20888).
Competing interests None declared.
Patient consent Not required.
Ethics approval University of Miami School of Medicine IRB.
Provenance and peer review Not commissioned; externally peer reviewed.