Gastric polyps in pernicious anaemia: indication for polypectomy

History and clinical findings: A 54-year-old man was admitted to hospital w ith dyspnoea, giddiness, lack of appetite and burning sensation in the tong ue for 3 years. Gastritis was known from his history. Clinical examination showed jaundice, glossitis, systolic murmur and pallhypaesthesia of both le gs. Investigations: Blood and bone marrow investigations revealed pernicious an aemia. At gastroscopy, fundal gastritis was diagnosed and two small polyps of the fundus were removed. Histologically, one of the two polyps turned ou t to be a gastric carcinoid type 1 (according to [16]). Additional investig ations (x-ray, ultrasound of the abdomen, somatostatin-receptor scintigraph y) did not find any metastases. Treatment and course: With the diagnosis of a pernicious anaemia the patien t was treated with vitamin B-12. The original symptoms and the anaemia disa ppeared. Additional therapy of the gastric carcinoid was not necessary. One year after beginning of the treatment, no signs of the gastric carcinoid w ere found. Conclusion: In gastric polyps of patients with pernicious anemia neoplastic transformations will often be found. That is why polypectomy should always be done. The best therapy of the gastric carcinoids type 1, which are the most frequently gastric carcinoids, is endoscopic tumour removal. Surgery i s the treatment of choice only for gastric carcinoids type 2 to 4. Concerni ng quality of life and costs, endoscopic treatment is better for patients w ith gastric carcinoids type 1 than conventional surgical therapy.