Approach to Fundic Gland Polyps and VCE for Polyposis Syndromes

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AS Sami et al. JPGN 2023; 77: 439-441. Fundic Gland Polyps: Strategizing a Surveillance Framework for Children and Adolescents

Key points:

  • Most fundic gland polyps (FGPs) are small (0.1 to 1 cm) sessile polyps characterized histologically by cystic oxyntic glands with a mixture of parietal cells and chief cells.
  • Most FGPs are “sporadic” and associated with chronic PPI use. These are benign.
  • Syndromic FGPs are associated with familial adenomatous polyposis (FAP) and have a “0.6% lifetime risk of progressing to gastric carcinoma.” 73% of syndromic FGPs had low-grade dysplasia in one study.
  • Routine excision of FGPs is not recommended in the absence of high-risk features (see below)

In Figure 1, the authors outline an algorithm for surveillance:

Sporadic: If FGPs are thought to be sporadic and have no dysplasia, no follow-up is needed. If FGPs are thought to be sporadic, but have dysplasia, “consider diagnostic workup for syndromic FGP.” “Surveillance by EGD of sporadic FGPs with our without low-grade dysplasia is not routinely recommended, as progression to gastric cancer is rare… In patients with multiple FGPs (eg. carpeted polyposis), large (>1 cm) polyps, or the presence of high-grade dysplasia, FAP needs to be ruled via genetic testing and colonoscopy.”

Syndromic: If low risk FGP, then surveillance recommended beginning at 25 years of age. If high risk FGP, surveillance is recommended every 1-2 years. High-risk features include multiple FGPs (eg. carpeted polyposis), large (>1 cm) polyps, or the presence of high-grade dysplasia

C Phen, TM Attard. JPGN 2023; 77: 442-444. The Role of Capsule Endoscopy in the Management of Pediatric Hereditary Polyposis Syndromes

In this review, the authors recommend VCE for Peutz-Jeghers syndrome no later than 8 years of age; for constitutional mismatch repair deficiency, the authors recommend “consider VCE surveillance before age 10.”

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