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Gastric epithelial polyps are usually detected incidentally at endoscopy. The majority are fundic gland polyps or hyperplastic polyps, which usually are small, single or multiple. Fundic gland polyps have no malignant potential and do not usually require removal or endoscopic surveillance. There is an increased prevalence of fundic gland polyps in patients taking PPIs. When multiple (more than 20) fundic gland polyps are found or concomitant duodenal adenomas are present, the possibility of familial polyposis should be considered. Large hyperplastic polyps (greater than 1.0 cm) should be removed at endoscopy as they may rarely cause chronic blood loss and iron deficiency anemia and up to 19% may harbor dysplasia. Adenomatous polyps account for 10–20% of gastric polyps. They are usually solitary lesions that usually arise in a background of chronic atrophic gastritis associated with H pylori infection, which should be treated, if present. In rare instances they ulcerate, causing chronic blood loss. Because of their premalignant potential, endoscopic removal is indicated. Regular endoscopic surveillance is recommended to screen for further adenoma development. Submucosal gastric polypoid lesions include benign gastric stromal tumors (commonly misclassified as leiomyomas) and pancreatic rests. (See Chapter 39 for Gastric Adenocarcinoma, Lymphoma, Carcinoid Tumors, and Mesenchymal Tumors.)

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Chen  H  et al. Current status of endoscopic resection of gastric subepithelial tumors. Am J Gastroenterol. 2019;114:718.
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Vos  S  et al. Gastric epithelial polyps: when to ponder, when to panic. Surg Pathol Clin. 2020;13:431.
[PubMed: 32773193]  

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