Gastric adenoma

Gastric adenoma (Gastric adenoma)

1) Disease Description (Causes and Symptoms)

• Definition: An adenomatous polyp arising from the gastric mucosa. In pathology, it is classified as low-grade, intermediate-grade, or high-grade dysplasia (or low-grade vs. high-grade dysplasia).
• Causes and pathophysiology: Abnormal proliferation occurs during chronic inflammation (chronic gastritis), mucosal damage, and the regeneration process. Intestinal metaplasia or atrophic gastritis often accompanies it. When Helicobacter pylori infection is present, the risk may increase.
• Symptoms: Most cases are asymptomatic and are discovered incidentally during endoscopy. Rarely, large lesions may be accompanied by bleeding, malabsorption, or nonspecific indigestion.
• Risk of malignant transformation (based on the provided data): Reports indicate that cancerous foci are present in more than 40% of all gastric adenomas, and the frequency of cancerization varies according to lesion diameter — the incidence of cancer is < 5% when the diameter is ≤ 2 cm and 24–55% when it is ≥ 2 cm.

2) Treatment Methods and Precautions

• Diagnosis: Upper gastrointestinal endoscopy (a biopsy must be performed before ESD/EMR). The grade of dysplasia (low-grade vs. high-grade) is confirmed by pathology.
• Standard treatment
  • Definitive removal is recommended for most gastric adenomas because of their potential for malignant transformation.
  • Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is the first-line treatment. The method is selected according to the lesion’s size, shape, and signs of invasion.
  • If endoscopic resection is not possible or invasion is suspected (an invasive lesion in which actual cancer is suspected), surgical resection, such as partial gastrectomy, may be considered.
• Medication and other treatments
  • H. pylori eradication therapy is recommended if the test is positive (it may help reduce the risk of gastric cancer and recurrence).
  • General treatment to prevent bleeding and infection; transfusion, antibiotics, and other measures if necessary.
• Complications and precautions
  • After endoscopic resection, bleeding, perforation, infection, and recurrence due to incomplete resection at the resection margin may occur.
  • The use of anticoagulants and antiplatelet drugs must be adjusted before treatment (follow the doctor’s instructions before resection).
  • Additional treatment, such as further resection or surgery, may be necessary depending on the pathology results after resection.
• Prognosis
  • The prognosis is good if the lesion is completely resected, but additional treatment and periodic follow-up are necessary if high-grade dysplasia or invasive cancer is found. Lesion size and the degree of dysplasia affect the prognosis.

(The follow-up interval varies according to the pathology findings and resection status. Usually, examinations are performed every 6–12 months during the first year and then adjusted to intervals such as once a year; this may vary depending on the institution and clinical guidelines.)

3) Outpatient Visit Checklist (Including Preparation and Example Questions)

• Items to prepare and bring
  • A list of current medications (especially anticoagulants and antiplatelet drugs such as aspirin, clopidogrel, warfarin, and DOACs)
  • Previous endoscopy images, reports, and pathology results, if available
  • Information about previous surgeries and chronic diseases, such as cardiovascular disease and diabetes
  • Allergy history, including medications and anesthetics
  • Identification card and insurance card
• Items to confirm before the appointment
  • Current symptoms, such as abdominal pain, vomiting, weight loss, and black stools
  • Medication schedule and whether medications can be stopped (follow the doctor’s instructions if anticoagulant adjustment is needed)
  • Whether fasting is required (generally fasting for 6–8 hours before endoscopy)
  • Whether blood coagulation tests, such as INR, are needed
• Example questions to write down in advance for the doctor
  • Whether endoscopy and a biopsy are planned, and an explanation of the procedures
  • If resection is planned, whether hospitalization is required, how long it will take, and the recovery period

(Department: Gastroenterology)

4) General Example Questions to Ask the Doctor

• "What were the results of the biopsy of my lesion, including the degree of dysplasia? Are there any signs of cancer?"
• "Can this lesion be completely removed by endoscopic resection? Which method do you recommend, EMR or ESD?"
• "What risks, such as bleeding and perforation, are expected during treatment, and how long is the recovery period?"
• "Should I be tested for H. pylori? If the result is positive, will eradication therapy be necessary?"
• "What will the follow-up endoscopy schedule be after resection?"

5) Disease-Specific Example Questions (1–2 Specialized Questions)

• "Please explain specifically the lesion’s size and shape on endoscopy, including surface ulceration and signs of invasion, and whether the biopsy shows low-grade or high-grade dysplasia. Based on these results, what treatment plan should be expected?"
• "If I need to stop the anticoagulant I am currently taking, how long beforehand should I stop it, and what measures will be taken to address the risks of stopping it, such as the risk of thrombosis?"

Summary: Gastric adenomas are usually asymptomatic, but because they can progress to cancer, endoscopic tissue diagnosis and appropriate resection are important. Treatment methods, follow-up intervals, and management of complications vary depending on the lesion’s size, pathology results, and the patient’s condition, so please consult a gastroenterology specialist in detail.