Positive predictive value of endoscopic features deemed typical of gastric fundic gland polyps

Background: Fundic gland polyps (FGPs) are now the most common gastric polyp encountered by endoscopists. However, they have minimal clinical significance. If they could be reliably predicted by endoscopic features, it might prevent the need for and cost of biopsy. Goals: To determine the positive predictive value of endoscopic criteria deemed characteristic of FGPs. Study: We prospectively identified 56 consecutive patients with one or more gastric polyps deemed typical of FGPs by endoscopic criteria and submitted them for histologic analysis. Patients with familial adenomatous polyposis were excluded. Results: Histologic examination confirmed that 50 (89.3%) of the 56 polyps were FGPs. Of the six polyps incorrectly predicted to be FGPs, three were determined to be of normal gastric body-type mucosa, one was uninterpretable secondary to squeeze artifact, one was a lymphoid aggregate with mucosal edema, and one was polypoid regenerative mucosa in the setting of chronic active gastritis and Helicobacter pylori infection. Conclusions: As sporadic FGPs are common and can be predicted with a high degree of accuracy based on endoscopic evaluation, it may not be necessary to submit them for pathologic examination. This practice would result in cost savings.