Dysplastic changes in gastric fundic gland polyps of patients with familial adenomatous polyposis

Background. Fundic gland polyps are the most common gastric lesion in patie nts with familial adenomatous polyposis and are traditionally considered a condition with no malignancy potential. However some reports have recently, questioned this view. Aims, To prospectively evaluate their prevalence and the associated dysplas tic/malignant changes in a series of affected patients. Patients and Methods. Thirty-seven affected patients were carefully investi gated by upper endoscopy over a three-year period. Multiple (at least 10) c omplete excisions of any representative polyp of the body-fundus were perfo rmed and a through pathological search for microscopic adenomatous/dysplast ic changes carried out. Results, Of 37 patients, 19 (51.3%) showed gastric fundic gland polyposis a nd 18 of them gave consent for polypectomies. Overall, 425 endoscopic polyp ectomies were per formed, with a mean of 23.6 +/- 14.6 per patient. At path ology all excised polyps of the body-fundus were found to be fundic glandul ar Microscopic adenomatous changes within such polyps were identified in 8 (44.4%) patients. All the adenomatous foci revealed mild dysplasia with no case of severe atypia or carcinoma. Patients with microadenomas showed a si gnificantly higher total number of gastric polyps compared with those witho ut microadenomas (p<0.03). No other differences between the two groups were observed Two further patients presented microadenomas in apparently normal antral mucosa and one also showed a 6 mm antral adenoma with mild dysplasi a. Finally, the search for Helicobacter pylori was always negative. Conclusions. Patients with familial adenomatous polyposis and gastric fundi c gland polyps have a high prevalence of microscopic adenomatous foci withi n such lesions; nevertheless, these foci seem not to be associated with sig ns of severe atypia or carcinoma. Moreover microadenomas are ubiquitous thr oughout the stomach, as well as in the rest of the gut, and their natural h istory is still undefined. Thus, their malignancy potential remains uncerta in. More Extensive follow-rip is warranted to better investigate the longte rm biological behaviour of these lesions brit, at present, our data do nor support the need for a change in the usual intervals of upper endoscopy sur veillance in familial polyposis patients with or without gastric fundic gla nds polyps.