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

Background. Fundic gland polyps are the most common gastric lesion in patients 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 dysplastic/malignant changes in a series of affected patients. Patients and Methods. Thirty-seven affected patients were carefully investigated by upper endoscopy over a three-year period. Multiple (at least 10) complete excisions of any representative polyp of the body-fundus were performed and a through pathological search for microscopic adenomatous/dysplastic changes carried out. Results, Of 37 patients, 19 (51.3%) showed gastric fundic gland polyposis and 18 of them gave consent for polypectomies. Overall, 425 endoscopic polypectomies were per formed, with a mean of 23.6 +/- 14.6 per patient. At pathology all excised polyps of the body-fundus were found to be fundic glandular 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 significantly higher total number of gastric polyps compared with those without microadenomas (p