Gastroesophageal Junction Hyperplastic (Inflammatory) Polyps: A Clinical and Pathologic Study of 46 Cases
KB Long, RD Odze. Brigham and Women's Hospital, Boston, MA
Background: Hyperplastic (inflammatory) polyps (HPs) of the gastric corpus and antrum typically develop as a result of an underlying chronic inflammatory condition. However, little is known regarding the etiology of HPs of the gastroesophageal junction (GEJ). We have noted, anecdotally, that GEJ HPs often occur in patients without gastric pathology. The aim of this study was to evaluate the clinical and pathologic features of HPs from the GEJ, and to compare the data to HPs that occur in the distal stomach.
Design: 134 consecutive polyps of the GEJ were identified by a 5-year search through the pathology files of a major tertiary care hospital. Of these, 46 (34%) polyps from 46 patients met the pathologic criteria for HPs and form the basis of this study. The 46 study patients, and their polyps, were evaluated for a wide variety of clinical, endoscopic, and pathologic features, including their association with Barrett's esophagus (BE) and chronic gastritis, among others. The findings were compared to 46 HPs (from 46 patients) of the distal stomach that were obtained randomly from the same 5-year time period.
Results: Compared to patients with distal gastric HPs, patients with HPs of the GEJ were younger (mean age: 55.9 years vs 63.0 years; p=0.04) and showed a higher M:F ratio (52.2% vs 34.8%). Pathologically, GEJ HPs showed a significantly higher rate of positivity for multilayered epithelium (p=0.006) and association with BE (p=0.03). All BE-associated GEJ HPs were associated with either ultrashort (<1 cm) or short-segment (1-3 cm) BE. All other pathologic variables, including intestinal metaplasia, were similar to those of distal stomach HPs. In a subanalysis, BE-associated GEJ HPs (33% of all GEJ HPs) showed a higher M:F ratio, higher incidence of GERD symptoms (p=0.05), and lack of association with chronic gastritis or H. pylori infection, compared to all other HPs. Only one HP (from the GEJ) from both patient groups was associated with a neoplasm (signet ring cell carcinoma). Upon follow up (17% of patients; mean follow up time: 15 months), only one patient with a GEJ HP and 4 with distal stomach HPs developed recurrent HPs, but none of the patients developed dysplasia or carcinoma.
Conclusions: Unlike HPs of the distal stomach, a significant number of HPs of the GEJ arise in association with BE, and without gastric pathology. In patients with BE, the columnar-lined segment is often ultrashort, and thus a HP may be the first clinical/endoscopic manifestation of this disorder.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 63, Wednesday Morning