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©2013 UpToDate ® Print Email ASGE recommendations for gastric polyps 1. Polypoid defects of any size detected radiographically should be evaluated endoscopically, with biopsy and/or removal of the lesions. 2. Polyps causing symptoms, such as obstruction and bleeding, should be removed, preferably, endoscopically. 3. Polyps greater than 2 cm. in size should be endoscopically excised wherever feasible. If endoscopic polypectomy is not possible, the polyp should be biopsied. If adenomatous tissue is detected, referral for surgical excision should be considered. If no adenomatous tissue is detected, management must be individualized. It is felt that there is a reasonable chance that endoscopic biopsy could have overlooked adenomatous change in a mixed polyp (as might be seen, for example in a pedunculated polyp where sampling from all areas is difficult), referral for surgical excision is reasonable. 4. Polyps less than 2 cm. in size may be initially biopsied or excised. If representative biopsies are obtained and the polyp non-adenomatous, no further intervention is necessary. If biopsies reveal adenomatous change, endoscopic excision should be considered wherever feasible. 5. When multiple gastric polyps are encountered, the largest polyp should be biopsied or excised, and representative sample biopsies taken from some others. Further management should be based on histologic results. 6. Surveillance endoscopy one year after removing adenomatous gastric polyps is reasonable to assess recurrence at prior excision site, new or previously missed polyps and/or supervening early carcinoma in gastric mucosa apart from the site of coincident polyps. If this examination is negative, repeat surveillance endoscopy should be repeated no more frequently than three to five year intervals. 7. No surveillance endoscopy is necessary after removal of non-adenomatous gastric polyps. These guidelines are available on the World Wide Web: file://www.asge.org/WorkArea/showcontent.aspx?id=3304.