Gastric polyps

　　The etiology is unknown at present. Gastric polyps refer to elevated lesions originating from gastric mucosal epithelial cells protruding into the stomach. Gastric polyps generally occur more often in the antrum of the stomach, and a few can also be seen in the upper part of the corpus, the cardia, and the fundus. Pathologically, they are mainly divided into hyperplastic polyps and adenomatous polyps.

　　1. Hyperplastic polyps

　　This type of polyp accounts for 75% to 90% of gastric polyps and is a polypoid mass formed by inflammatory mucosal hyperplasia, not a true tumor. The polyps are small, generally less than 1.5cm in diameter, spherical or olive-shaped, with a pedicle or without a pedicle, smooth in surface, and may be accompanied by erosion. Histologically, hyperplastic gastric crypt epithelium and hyperplastic lamina propria glands can be seen, with good epithelial differentiation, rare nuclear division, inflammatory cell infiltration in the lamina propria, and some polyps accompanied by intestinal metaplasia. A few hyperplastic polyps can undergo atypical hyperplasia or adenomatous transformation, resulting in malignancy, but the rate of malignancy is generally not more than 1% to 2%.

　　2. Adenomatous polyps

　　Gastric polyps are benign gastric tumors originating from the gastric mucosal epithelium, accounting for 10% to 25% of gastric polyps. Generally, they are larger, spherical or hemispherical, most of which are sessile, with a smooth surface. A few are flat, striated, or lobulated. Histologically, they are mainly formed by the hyperplasia of the surface epithelium, crypt epithelium, and glands. The differentiation of the epithelium is immature, with frequent nuclear division. They can be classified into tubular, villous, and mixed adenomas, often accompanied by marked intestinal metaplasia and atypical hyperplasia. The stroma of the polyps is loose connective tissue, with a small number of lymphocytes infiltrating. The mucosal muscular layer shows no obvious hyperplasia, and there is no dispersion of muscle fibers. This type of polyp has a high rate of malignancy, reaching 30% to 58.3%, especially in polyps with a diameter greater than 2cm, villous adenomas, and atypical hyperplasia of grade III, where the rate of malignancy is even higher.

　　Gastric polyps with erosion or ulcers can cause upper gastrointestinal bleeding, which is often manifested as positive fecal occult blood test or black stools, while hematemesis is rare. Pedunculated polyps located in the pyloric region can prolapse into the pyloric canal or duodenum, leading to the symptoms of pyloric obstruction. When polyps grow near the esophagus, there may be difficulty in swallowing.

      The vast majority of gastric polyps are discovered incidentally during endoscopic examination of the gastrointestinal tract, without any clinical symptoms. Only a small number of patients with gastric polyps experience gastrointestinal bleeding, which is common in larger hyperplastic or adenomatous polyps, and these symptoms are often non-specific. Some patients may also experience chronic anemia due to long-term chronic blood loss from the polyps. Larger polyps located near the pylorus can also cause pyloric obstruction, presenting with symptoms such as severe nausea, vomiting, and abdominal pain.

　　Different types of polyps can appear with special clinical manifestations, which are related to different etiologies. For example, gastritis associated with Helicobacter pylori infection can present with symptoms such as abdominal distension and early satiety, as well as digestive disorders. Lymphoma patients can have chronic fever and gastrointestinal bleeding. Carcinoid tumors can lead to carcinoid syndrome.

　　The main prevention of gastric polyps is the prevention of adenomatous polyps. Early detection is very important for adenomatous polyps with a tendency to cancer. Therefore, more and more doctors recommend colonoscopy screening for high-risk groups of gastric cancer, and early endoscopic or surgical treatment should be performed as soon as possible if gastric polyps with a risk of canceration are found. Since adenomatous polyps and hyperplastic polyps are more related to Helicobacter pylori infection, for these patients, Helicobacter pylori testing should be performed, and standardized radical treatment should be given to positive patients.

　　In daily life, it is necessary to cultivate good eating habits, reasonably arrange daily diet, eat more fresh fruits and vegetables rich in carbohydrates and rough fibers, and appropriately increase the proportion of coarse grains and mixed grains in staple foods. It should be tried to reduce the intake of preserved foods, and for high-risk groups, routine detection of Helicobacter pylori can be considered, and corresponding treatment should be given. In addition, it is also necessary to actively exercise, enhance physical fitness, improve immunity, relax oneself, relieve stress, and maintain a good attitude.

　　Since the vast majority of gastric polyps are benign lesions, only a few polyps have a high risk of malignancy, so it is also necessary to reduce the fear psychology and cooperate with the doctor's treatment with a correct attitude.

　　Since gastric polyps generally do not have clinical symptoms, and even if there are, the symptoms are not specific, the diagnosis of gastric polyps mainly depends on special instrumental examination. Commonly used in clinical practice include various gastrointestinal endoscopies, X-ray gastrointestinal contrast, CT scans, and so on.

　　1. Electronic gastroscopy

　　This is the main examination method for gastric polyps. In fact, most gastric polyps are found incidentally during endoscopic examination. The gastroscopy is inserted from the mouth and can examine the esophagus, stomach, and part of the duodenum. The gastroscopy can clearly observe the mucosal surface of the upper digestive tract and is very sensitive to elevated polyps, able to detect polyps as small as a few millimeters. With the continuous advancement of endoscopic technology, doctors can not only detect gastric polyps but also treat them and can make an initial judgment of the pathological type of the polyps. For gastric polyps, the most important thing is to differentiate between adenomatous polyps with a tendency to cancer and non-adenomatous polyps that do not lead to cancer. With the advancement of endoscopic technology, doctors can accurately judge the type of polyps through endoscopy and provide corresponding treatment. Under gastroscopy, the pathological nature of the polyps can be confirmed through biopsy.

　　2. X-ray gastrointestinal contrast

　　It refers to a diagnostic method that uses barium sulfate as a contrast agent to display whether there are any lesions in the digestive tract under X-ray irradiation, mainly including two methods: barium meal examination of the digestive tract and barium enema. During the barium meal examination of the digestive tract, the patient swallows barium sulfate, which is mainly used to examine the esophagus, stomach, and small intestine. X-ray examination can only detect a part of larger polyps and is often difficult to judge the nature of the polyps, so it often requires further electronic gastroscopy for confirmation. However, compared with gastroscopy, the advantages are safety, fewer complications, and relatively mild discomfort caused by the examination.

　　3. Other

　　With the continuous improvement of clinical diagnostic technology, CT simulation colonoscopy and positron emission tomography (PET) technology have emerged, which can also detect larger gastric polyps. And make different degrees of judgment on the nature of polyps.

　　To promote wound healing and physical recovery after gastric polyp surgery, it is necessary to consume foods rich in protein and vitamins, such as eggs, meats, fish, beans, milk, fruits, green leafy vegetables, etc. It is also possible to take a complete vegetarian diet under the guidance of a doctor. That is to say, there is no special restriction on the type of food. However, in order to adapt to the decrease in digestive capacity, appropriate adjustments should be made in terms of the quantity and quality of food. The dietary care after gastric polyp surgery generally includes the following points that need to be paid attention to, for reference only, and patients should follow the doctor's advice on diet.

　　1. Postoperative fasting is required until the intestinal peristalsis recovers and anal exhaust occurs. On the day the gastric tube is removed, a small amount of water can be taken, 4 to 5 tablespoons each time, every 2 hours.

　　2. If there are no adverse reactions, appropriate clear liquid food can be given the next day, 50 to 80 ml per time.

　　3. On the third day, full-quantity liquid food is given, 100 to 150 ml each time. Have 6 to 7 meals a day, with the dietary principle being: non-irritating food, liquid consistency, eat small meals more frequently, eat once every 2 to 3 hours, choose non-bloating, not too sweet foods, such as egg soup, rice soup, vegetable soup, lotus root powder, etc. After meals, it is advisable to lie flat for 20 to 30 minutes.

　　4. If the postoperative condition returns to normal, low-fat semi-liquid food can be eaten two weeks after surgery, such as congee, noodles, wontons, etc., with 5 to 6 meals a day. The dietary principle is: semi-liquid consistency, with protein content reaching the normal requirement, and very low fiber content. Eat small meals more frequently.

　　5. After discharge, patients can eat soft food. The main food and side dishes should be selected for their nutritional value and easy digestion. Avoid cold and greasy foods, spicy and sour foods that are easy to cause bloating. Patients should chew slowly and eat more fresh vegetables and fruits. Avoid high-fat foods and preserved products. Iron and vitamin supplements should be taken in moderation. Abstain from smoking and drinking. Have regular meals. After 3 to 6 months post-operation, the diet can be gradually restored to normal according to the physical condition.

　　6. The patient's diet should be based on the feeling of no discomfort, with low residue, mild, and easy-to-digest food as the principle. Eat small meals more frequently and avoid overly sweet, salty, and strong-tasting foods. If nausea or bloating occurs after eating, stop eating.

　　The main food and side dishes should be selected for their nutritional value and easy digestion. It is advisable to avoid cold and greasy foods, as well as spicy and sour foods that are easy to cause bloating. Patients should chew slowly and eat fresh vegetables and fruits more. Avoid high-fat foods and preserved products. Iron and vitamin supplements should be taken in moderation. Abstain from smoking and drinking. Have regular meals. After 3 to 6 months post-operation, the diet can be gradually restored to normal according to the physical condition.

　　The main methods of treating gastric polyps are to remove them through endoscopy or surgery. However, with the development of medicine, more treatment methods for gastric polyps have emerged. Therefore, the following will detail the various methods of treating gastric polyps.

　　1. Endoscopic treatment: Endoscopic resection is the first choice for the treatment of gastric polyps, mainly including high-frequency electrocoagulation resection, laser and microwave ablation, nylon thread ligation, and argon plasma coagulation. Endoscopic treatment of polyps is simple, minimally invasive, low-cost, and most are treated once, with a few requiring staged resection. Regular follow-up through endoscopy can also detect polyp recurrence and provide timely treatment to prevent cancer.

　　2. High-frequency electrocoagulation resection method: This is the most widely used method. Its principle is to use the thermal effect generated by high-frequency current to coagulate and necrose the tissue to achieve the purpose of resecting the polyp.

　　3. Microwave ablation method: Utilizing the principle that microwaves can cause polar molecules to vibrate and produce a thermal effect, the tissue is coagulated and vaporized to remove the polyp, and it also has a hemostatic effect. It is suitable for pedunculated polyps with a diameter less than 2 cm. Smaller polyps can be removed in one go, while larger ones require multiple treatments.

　　4. Nylon thread and rubber ring ligation method: By ligating the root of the polyp, it causes ischemic necrosis to achieve the therapeutic purpose.

　　5. Argon plasma coagulation: Argon gas can be transmitted by ionization conduction from the high-frequency electric energy generated by the tungsten wire electrode, causing the tissue to undergo a coagulation effect. In recent years, it has been applied in endoscopic treatment and has achieved good therapeutic effects.

　　6. Cryotherapy: Refrigerant gas is sprayed directly on the surface of the polyp or the lesion is contacted frozen with a special cryogenic rod through a specially designed catheter through the endoscopic biopsy hole, causing tissue necrosis and shedding. Since this method is difficult to cure a single large polyp in one go, it is currently rarely used.

　　7. Radiofrequency method: Radiofrequency is a type of electromagnetic wave ranging from 200 to 750 kHz. After entering the lesion tissue, it locally heats up to evaporate moisture and dry it out, leading to necrosis to achieve the therapeutic purpose.

　　8. Alcohol injection method: Under endoscopy, a spot injection is made around the base of the polyp with anhydrous alcohol, with each point being ml, and the white papillary elevation is the limit. This method is generally only used for the treatment of broad-based polyps.

　　9. Laser method: High-energy laser generated by a laser is introduced into the lesion site through an optical fiber through the endoscopic biopsy hole, and the tissue protein is coagulated, denatured, and destroyed by the thermal energy converted from light energy to achieve the therapeutic purpose.