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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (6): 1122-1127. doi: 10.19723/j.issn.1671-167X.2021.06.019

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Analysis of endoscopic and pathological features of gastric adenomatous polyps and risk factors for canceration

NIU Zhan-yue,XUE Yan,ZHANG Jing,ZHANG He-jun,DING Shi-gang()   

  1. Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-03-31 Online:2021-12-18 Published:2021-12-13
  • Contact: Shi-gang DING E-mail:dingshigang222@163.com

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Abstract:

Objective: To investigate the endoscopic and pathological characteristics of gastric adenomatous polyps and to assess the potential risk factors for canceration of gastric adenomatous polyps. Methods: The endoscopic and pathological characteristics of the patients with gastric adenomatous polyps from January 1, 2005 to December 31, 2019 were summarized retrospectively, and the risk factors of canceration were analyzed. Results: A total of 125 patients with gastric adenomatous polyps were included, 51.20% of whom were females. The average age was (66.7±12.3) years. 64.80% of patients with gastric adenomatous polyps equal or more than 65 years old, and only 5.60% of the patients less than 45 years old. Adenomatous polyps were mostly distributed in the corpus and antrum with 40.80% and 32.80%, respectively. The majority of them were single (90.40%) and sessile (76.81%). 65.4% of adenomatous polyps were no more than 1.0 cm in diameter, and 23.20% of patients with adenomatous polyps were combined with hyperplastic polyps and/or fundus glandular polyps, and 1.60% had both pathological types of polyps. 58.62% (17/29) patients with hyperplastic polyps and/or fundus glandular polyps had multiple polyps. 1.60% (2/125) of the patients had gastric neuroendocrine tumor of G1 stage. Synchronous gastric cancer was detected in 13.60% (17/125) of the patients with adenomatous polyps, and the proportion of low-grade intraepithelial neoplasia was 18.40% (23/125). The main types of synchronous gastric cancer were progressive (70.59%) and undifferentiated (66.67%). Chronic atrophic gastritis with intestinal metaplasia was found in 52.80% of the patients, and autoimmune gastritis accounted for 11.20%. The positive rate of Helicobacter pylori was 21.60%. The canceration rate of gastric adenomatous polyps was 20.80%. The cancer was mainly differentiated, but there was sigmoid ring cell carcinoma as well. Diameter of >1.0 cm (OR=5.092, 95%CI: 1.447-17.923, P=0.011), uneven surface morphology and erosion (OR=13.749, 95%CI: 1.072-176.339, P=0.044) were independent risk factors of adenomatous polyps. Conclusion: The synchronous gastric cancer is common and the canceration of gastric adenomatous polyps is high with diameter and surface morphology as independent risk factors. We should pay attention to the identification of the pathological types of polyps and the evaluation of the whole gastric mucosa during the endoscopic examination.

Key words: Adenomatous polyps, Neoplasms, multiple primary, Endoscopy, gastrointestinal, Risk factors

CLC Number: 

  • R735.2

Table 1

Basic data of gastroscopy and gastric adenomatous polyp"

Year Gastroscopy, n Gastric adenomatous polyp, n (%)
2005 4 389 3 (0.07)
2006 7 185 8 (0.11)
2007 8 511 10 (0.12)
2008 9 192 7 (0.08)
2009 11 116 6 (0.05)
2010 11 348 4 (0.04)
2011 12 179 7 (0.06)
2012 13 772 13 (0.09)
2013 14 890 9 (0.06)
2014 16 404 8 (0.05)
2015 16 007 4 (0.02)
2016 17 592 13 (0.07)
2017 17 641 6 (0.03)
2018 19 422 17 (0.09)
2019 19 153 10 (0.05)
Total 198 801 125 (0.06)

Table 2

Gastroscopic features of adenomatous polyp"

Gastroscopic features n (%)
Location
Cardia 10 (8.00)
Fundus 10 (8.00)
Body 51 (40.80)
Incisura angularis 5 (4.00)
Antral 41 (32.80)
Multiple 8 (6.40)
Number
Single 113 (90.40)
Multiple (n≥2) 12 (9.60)
Diameter/cm
≤0.5 32 (23.19)
>0.5-1.0 59 (42.75)
>1.0-1.5 15 (10.87)
>1.5-2.0 15 (10.87)
>2.0-2.5 5 (3.62)
>2.5-3.0 3 (2.17)
>3.0 9 (6.52)
Yamada type
Ⅰ 73 (52.90)
Ⅱ 33 (23.91)
Ⅲ 20 (14.49)
Ⅳ 12 (8.70)

Figure 1

Endoscopic and pathological manifestations of adenomatous polyps and canceration A, adenomatous polyp of antrum, smooth surface, same color as the surrounding mucosa; B, pathological manifestations of adenomatous polyp (HE ×10); C, canceration of cardiac adenomatous polyp with rough and reddish surface; D, the pathology of cancerous adenomatous polyp (HE ×20)."

Table 3

Comorbid gastric disease with adenomatous polyp"

Disease n (%)
Other types of polyp
Fundic gland polyp
Single 0 (0)
Multiple 3 (2.40)
Hyperplastic polyp
Single 12 (9.60)
Multiple 12 (9.60)
Both 2 (1.60)
Neuroendocrine tumor
G1 2 (1.60)
G2 0 (0)
G3 0 (0)
Low grade intraepithelial neoplasia 23 (18.40)
High grade intraepithelial neoplasia 3 (2.40)
Early cancer 2 (1.60)
Advanced gastric cancer
Differentiated 4 (3.20)
Undifferentiated 8 (6.40)

Table 4

The pathological features of adenomatous polyp"

Pathological features n (%)
Polyp
High grade intraepithelial neoplasia 10 (8.00)
Canceration 16 (12.80)
Background
Chronic superficial gastritis 24 (19.20)
Autoimmune gastritis 14 (11.20)
Chronic atrophic gastritis 21 (16.80)
Chronic atrophic gastritis with intestinal metaplasia 66 (52.80)
Helicobacter pylori 27 (21.60)

Table 5

Risk factors for canceration of adenomatous polyp"

Risk factors Canceration, n Non-canceration, n χ2 P value
Gender
Male 9 52 2.644 0.104
Female 17 47
Age
<45 0 7 6.353 0.174
45-54 2 13
55-64 3 19
65-74 14 30
≥75 7 30
Location
Cardia 3 7 8.789 0.118
Fundus 4 6
Body 7 44
Incisura angularis 1 4
Antral 7 34
Multiple 4 4
Number
Single 21 92 3.509 0.061
Multiple (n≥2) 5 7
Diameter/cm
≤1.0 7 74 28.868 <0.001
1.1-2.0 7 20
2.1-3.0 5 3
>3.0 7 2
Type
Pedicless 16 80 4.291 0.038
Pedicled 10 19
Color
Normal 11 57 2.138 0.343
Red 11 33
White 4 9
Surface
Smooth 7 65 20.538 0.001
Rough 8 18
Lobulated 5 8
Erosion 1 6
Rough and erosion 3 1
Lobulated and erosion 2 1
Background
Chronic superficial gastritis 2 22 4.303 0.231
Autoimmune gastritis 4 10
Chronic atrophic gastritis 3 18
Chronic atrophic gastritis with intestinal metaplasia 17 49
Helicobacter pylori
Positive 5 22 0.125 0.724
Negative 21 76

Table 6

Multivariate Logistic regression analysis of risk factors for canceration"

Risk factors OR (95%CI) P value
Diameter/cm
≤1.0 1
>1.0 5.092 (1.447-17.923) 0.011
Type
Pedicled 1
Pedicless 1.120 (0.343-3.654) 0.852
Surface
Normal 1
Rough 1.850 (0.496-6.895) 0.360
Lobulated 2.339 (0.489-11.183) 0.287
Erosion 1.641 (0.154-17.519) 0.682
Rough and erosion 13.749 (1.072-176.339) 0.044
Lobulated and erosion 5.617 (0.389-81.126) 0.205
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