| Abstract | Polipi želuca pronalaze se u 1-8 % endoskopija gornjeg gastrointestinalnog trakta, najčešće kao slučajan nalaz. Hiperplastični polipi želuca (HPŽ) čine 30-93% otkrivenih polipa, čest su nalaz u zemljama s visokom prevalencijom H.pylori infekcije. Procjenjuje se da je rizik za neoplastičnu transformaciju unutar polipa u rasponu od 1,5 do 4,5 %, pri čemu je prevalencija nastanka adenokarcinoma izvan HPŽ veće nego unutar polipa (6% vs. 2%).
U ovoj retrospektivnoj studiji koristili smo uvid u medicinsku dokumentaciju, nalaze endoskopske obrade i biopsije u 36 pacijenata koji su u periodu od 2012. do 2021. hospitalizirani na Zavodu za gastroenterologiju KBCSM zbog resekcije HPŽ. Cilj studije bio je prikazati trendove recidiviranja i pojave karcinoma unutar HPŽ, rizične čimbenike u nastanku i transformaciji, te pokušati definirati preporuku o resekciji i praćenju ovih polipa.
U inicijalnoj obradi identificirano je 36 bolesnika sa 144 polipa od čega je resecirano 98 HPŽ. Više su bili zastupljeni muškarci (63,9%), medijan dobi bio je 71,5, a prosječan broj polipa po pacijentu 3,8. Polipi su bili smješteni antralno u 75% pacijenata, a simptome je imalo 58,3% bolesnika. Primarni recidiv HPŽ zabilježen je kod 50% pacijenata nakon inicijalne resekcije. U univarijatnoj analizi statistički značajnim za recidiv pokazao se broj reseciranih polipa (RR 5,14 uz CI 95% 1,17-22,48 p=0,03), te ne uzimanje ASK (0,18 uz CI 95% 0,040-0,820, p=0,027). Faktori ipak nisu značajni u multivarijatnoj analizi. Tijekom perioda praćenja, neoplastičnu transformaciju HPŽ zabilježi se u 19,4% svih sudionika, od čega je adenokarcinom utvrđen u 5,5% sudionika. Medijan perioda praćenja do pojave displazije je 9,5 mjeseci, dok je u slučaju recidiva 7,5. Na temelju Kaplan-Meierovih krivulja preživljenja, optimalni period za praćenje da bi se otkrili recidivi i displazija je procjenjen na 12 mjeseci. Dobivena učestalost recidiviranja i neoplastične transformacije u grupi pacijenata, ako se podaci obrađuju kao pacijent-slučaj, veća je od opisane u literaturi. Kao optimalni period praćenja nakon resekcije HPŽ, procjenjuje se na 12 mjeseci zbog toga se otkriva većina recidiva i displazija u HPŽ. |
| Abstract (english) | Gastric polips are an incidental finding in 1 to 8 % upper GIT endoscopies and hyperplastic gastric polyps (HGP) account for 30 to 93% of cases. The incidince is higher in countries with high H. pylori infection prevalence, but as the eradication strategies progress, the rate of HGP is falling. Studies estimate that the overall risk for neoplastic transformation in the polyp to be 1,5 – 4,5%. It is considered that the risk for adenocarcinoma development is higher in the adjacent mucosa than in the polyp itself (6% vs 2%).
In this retrospective study an analysis of medical records, endoscopy and biopsy results of 36 patients that were reffered to KBCSM Gastroenterology department for endoscopic GHP removal from 2009 to 2021 was conducted. The aim od this study is to define the trends and risk factors for HGP reccurence and neoplastic transformation in our patient group, as well as to review the resection and follow-up protocols.
A number of 36 patients, initially presented with 144 HGP of which 98 were resected endoscopically. The HGP in our patients are situated antrally (75%), multiple in number (3,8 per person), tend to occur in men (63,9%) and the average patients' age was 71,5 years. Symptoms were described in 58,3% of the patients with HGP. After iniatial resection, 50% of our patients with HGP had a primary reccurence. A univariant analysis found the number of resected polyps (RR 5,14,CI 95% 1,17-22,48 p=0,03) and not belonging to the acetylsalicyc acid therapy group(RR 0,18,CI 95% 0,040-0,820, p=0,027) as factors that are statistically significant for recurrence, but multivariant analysis did not follow through. During the follow up, 19,4% of the patients developed neoplastic changes in HGP, but no risk factors were proven significant in an univariate analysis. The median reccurence period is 6,5 months, while neplastic change was discovered after a median of 9,5 months since resection of GHP. The period of 12 months is consider to be the cut-off point to discover most recurrences and neoplastic changes. Finally, this study did show that the rates of recurrence and neoplastic transformation to be higher than expected in the literatureAlso, a follow up period of 12 months after the resection was confirmed to be the best option for follow-up and early neoplastic change detection. |
