Malignant progression and recurrence rates following endoscopic treatment of gastric hyperplastic polyps.

Objective: The evidence supporting gastric hyperplastic polyps (GHPs) management algorithms remains insufficient. To reassess the treatment criteria of these lesions, we analyzed the rate of GHPs' neoplastic progression and recurrence after endoscopic resection.

Methods: In this retrospective study from a high-volume center, we identified all patients diagnosed with GHPs between 2003 and 2022. Firstly, we cross-referenced patient records with the National Cancer Registry to identify cases of subsequent gastric cancer(GC), irrespective of endoscopic management. Secondly, we evaluated the prevalence of neoplastic components within resected GHPs and examined associated risk factors. Lastly, we analyzed patients who underwent endoscopic resection to assess the rate of local recurrences at endoscopic follow-up.

Results: A total of 889 patients were included (mean age 63.5 years; 66.9% female), with a median polyp size of 4mm (IQR 3-8mm). Over a median follow-up of 30.5 months (IQR: 11.1 - 61.2), GC developed in 3 patients (0.3%), yielding a cumulative incidence of 1.37% (95%CI:0.43%-4.30%). Of the 515 resected GHPs, neoplasia was found in 6 polyps(1.2%), all measuring ≥20mm, predominantly with pedunculated morphology (5/6 cases). Patients' age (odds ratio[OR] 1.15; 95%CI:1.01-1.36, p=0.040), and polyp size (OR 1.19; 95%CI:1.11-1.30, p<0.001) were associated with neoplasia. Follow-up data were available for 167 patients (32.4%), of whom 42(25.1%) developed local recurrence. Conclusions The risk of malignant progression in GHPs is low, while local recurrence after endoscopic resection remains notable. Endoscopic treatment should be prioritized for pedunculated polyps ≥20mm, as these are more likely to harbor neoplasia.