{"id":19287,"date":"2024-08-27T07:30:00","date_gmt":"2024-08-27T07:30:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=19287"},"modified":"2024-08-22T14:44:55","modified_gmt":"2024-08-22T14:44:55","slug":"polipos-hiperplasicos-na-endoscopia-risco-de-neoplasia-conduta-e-recidiva","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/polipos-hiperplasicos-na-endoscopia-risco-de-neoplasia-conduta-e-recidiva\/","title":{"rendered":"P\u00f3lipos Hiperpl\u00e1sicos na Endoscopia \u2013 Risco de Neoplasia, Conduta e Recidiva"},"content":{"rendered":"\n

Os p\u00f3lipos g\u00e1stricos s\u00e3o achados comuns, estando presente em 0,5% a 23% das endoscopias digestivas altas (1). A incid\u00eancia de cada tipo histol\u00f3gico \u00e9 vari\u00e1vel de acordo com a popula\u00e7\u00e3o estuda, sendo os p\u00f3lipos de gl\u00e2ndulas f\u00fandicas e os hiperpl\u00e1sicos os mais comuns. Um estudo feito no Brasil (2) mostrou que os p\u00f3lipos hiperpl\u00e1sicos s\u00e3o os mais prevalentes, correspondendo a 71,3% dos p\u00f3lipos, enquanto nos Estados Unidos (3) os de gl\u00e2ndulas f\u00fandicas s\u00e3o os mais comuns, representando 77%.<\/p>\n\n\n\n

Os p\u00f3lipos hiperpl\u00e1sicos s\u00e3o mais frequentes na sexta ou s\u00e9tima d\u00e9cadas de vida, com uma question\u00e1vel predomin\u00e2ncia no sexo feminino (4). Sua etiologia est\u00e1 geralmente associada a uma regenera\u00e7\u00e3o exacerbada da mucosa secund\u00e1ria a agress\u00e3o cont\u00ednua. Dessa forma, existe uma forte associa\u00e7\u00e3o entre o p\u00f3lipo hiperpl\u00e1sico e a presen\u00e7a de infe\u00e7\u00e3o pelo H. pylori, gastrite cr\u00f4nica, gastrite autoimune, metaplasia intestinal, gastropatia qu\u00edmica, cirrose hep\u00e1tica e p\u00f3s-terapia hemost\u00e1tica de angiectasias g\u00e1stricas (4,5). Na maioria dos casos s\u00e3o assintom\u00e1ticos no entanto, podem causar anemia, hemorragia digestiva ou at\u00e9 dificuldade do esvaziamento g\u00e1strico.<\/p>\n\n\n\n

Tipicamente eles s\u00e3o solit\u00e1rios, menores que 20 mm e localizados no antro (60%) (4), vide figuras 1 a 3. M\u00faltiplos p\u00f3lipos podem estar presentes em at\u00e9 20% dos casos (4). Geralmente s\u00e3o s\u00e9sseis, com superf\u00edcie lisa ou discretamente lobulada, fri\u00e1veis e hiperemiados. No entanto podem crescer e atingir tamanhos maiores que 100 mm, associado a eros\u00f5es ou \u00falceras superficiais em sua superf\u00edcie.<\/p>\n\n\n

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\"\"\n\t\t\t\n\t\t\t\t\n\t\t\t<\/svg>\n\t\t<\/button>
Figura 1: p\u00f3lipo hiperpl\u00e1sico em antro.<\/em><\/figcaption><\/figure>\n<\/div>\n\n
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\"\"\n\t\t\t\n\t\t\t\t\n\t\t\t<\/svg>\n\t\t<\/button>
Figura 2: p\u00f3lipo hiperpl\u00e1sico intruso no piloro.<\/em><\/figcaption><\/figure>\n<\/div>\n\n
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\"\"\n\t\t\t\n\t\t\t\t\n\t\t\t<\/svg>\n\t\t<\/button>
Figura 3: p\u00f3lipo hiperpl\u00e1sico extruindo do piloro.<\/em><\/figcaption><\/figure>\n<\/div>\n\n\n

Risco de maligniza\u00e7\u00e3o<\/strong><\/h2>\n\n\n\n

A presen\u00e7a de displasia ou malignidade pode ocorrer em 1,9% a 10,4% dos p\u00f3lipos hiperpl\u00e1sicos (6). No entanto essa preval\u00eancia pode variar de acordo com a popula\u00e7\u00e3o. Em pacientes asi\u00e1ticos a displasia pode ocorrer em 1,4% a 16,4% dos casos e malignidade em 1,1% a 4,4%. J\u00e1 em pacientes ocidentais a displasia pode acontecer em 3,3% a 9,7% dos casos e a malignidade em 0,6% a 2,1% (7).<\/p>\n\n\n\n

O principal fator de risco para a presen\u00e7a de displasia ou malignidade \u00e9 o tamanho do p\u00f3lipo, especialmente aqueles maiores que 25 mm (5,8). Outros fatores que podem estar associados s\u00e3o: idade maior que 65 anos, presen\u00e7a de metaplasia intestinal e displasia na mucosa adjacente (5,8).<\/p>\n\n\n\n

Conduta<\/strong><\/h2>\n\n\n\n

A Sociedade Americana de Endoscopia Gastrointestinal (ASGE) recomenda a ressec\u00e7\u00e3o de todos os p\u00f3lipos hiperpl\u00e1sicos maiores que 5 mm (9), enquanto o guideline brit\u00e2nico recomenda a retirada daqueles maiores que 10 mm (10). Outras indica\u00e7\u00f5es seriam a presen\u00e7a de displasia \u00e0 bi\u00f3psia ou p\u00f3lipos sintom\u00e1ticos (11).<\/p>\n\n\n\n

A pesquisa de H. pylori \u00e9 fundamental nesses casos, uma vez que existe uma associa\u00e7\u00e3o entre a presen\u00e7a do p\u00f3lipo hiperpl\u00e1sico e a infec\u00e7\u00e3o pelo H. pylori, que pode chegar a at\u00e9 37% (4,8). Al\u00e9m disso, a erradica\u00e7\u00e3o da bact\u00e9ria pode promover a regress\u00e3o do p\u00f3lipo em at\u00e9 84% dos casos, especialmente dos p\u00f3lipos menores, e parece reduzir as taxas de recidiva p\u00f3s-ressec\u00e7\u00e3o (12).<\/p>\n\n\n\n

Um exame cuidadoso do restante do est\u00f4mago tamb\u00e9m \u00e9 muito importante, pois esses pacientes apresentam outras altera\u00e7\u00f5es que predisp\u00f5e ao c\u00e2ncer g\u00e1strico, como atrofia g\u00e1strica e metaplasia intestinal. A taxa de les\u00f5es malignas sincr\u00f4nicas pode chegar a 7,1% (11).<\/p>\n\n\n\n

O seguimento endosc\u00f3pico ainda n\u00e3o est\u00e1 bem estabelecido. Recomenda-se repetir a endoscopia digestiva alta em 12 meses, especialmente naqueles pacientes que apresentaram displasia (11).<\/p>\n\n\n\n

Recidiva<\/strong><\/h2>\n\n\n\n

Os p\u00f3lipos hiperpl\u00e1sicos apresentam altas taxas recidiva, mesmo quando ressecados em monobloco (R0), podendo variar de 12% a 51% (6,8).  O tempo m\u00e9dio para o diagn\u00f3stico da recorr\u00eancia \u00e9 entre 1 e 2 anos e n\u00e3o necessariamente est\u00e3o associados a riscos maiores de displasia ou malignidade (5,12).<\/p>\n\n\n\n

O mecanismo pelo qual ela acontece ainda n\u00e3o est\u00e1 bem estabelecido. Aparentemente a t\u00e9cnica de ressec\u00e7\u00e3o, seja mucosectomia ou dissec\u00e7\u00e3o endosc\u00f3pica de submucosa n\u00e3o tem rela\u00e7\u00e3o a recidiva. A infec\u00e7\u00e3o pelo H. pylori, conforme descrito anteriormente, parece ter uma associa\u00e7\u00e3o tanto com o surgimento do p\u00f3lipo quanto com a sua recidiva ap\u00f3s a ressec\u00e7\u00e3o (12). Portanto seu tratamento deve ser sempre tentado. A localiza\u00e7\u00e3o no antro tamb\u00e9m se relaciona a uma maior recorr\u00eancia, acredita-se que pela maior contratilidade local e um prov\u00e1vel refluxo biliar (6). Outros fatores que podem estar associados s\u00e3o: p\u00f3lipos grandes (maiores que 16 mm), m\u00faltiplos, superf\u00edcie lobulada, idade menor que 65 anos e presen\u00e7a de cirrose (5,6).<\/p>\n\n\n\n

Conclus\u00e3o<\/strong><\/h2>\n\n\n\n

Os p\u00f3lipos hiperpl\u00e1sicos s\u00e3o achados relativamente comuns em endoscopias digestivas altas do dia a dia. Geralmente s\u00e3o pequenos e assintom\u00e1ticos. No entanto, devido ao risco de displasia e malignidade, mesmo que pequeno, eles devem ser ressecados, principalmente quando maiores que 10 mm. Deve-se dar aten\u00e7\u00e3o especial para a pesquisa de H. pylori e de outras entidades que podem estar associadas como gastrite, atrofia e metaplasia. Apesar de altas taxas de recidiva, ainda n\u00e3o est\u00e1 bem estabelecido nenhum protocolo de seguimento.<\/p>\n\n\n\n

Referencias<\/strong><\/h2>\n\n\n\n
    \n
  1. Yacoub H, Bibani N, Sabbah M, et al. Gastric polyps: a 10-year analys of 18,496 upper endoscopies. BMC Gastroentereol. 2022;22:70.<\/li>\n\n\n\n
  2. Morais DJ, Yamanaka A, Zeitume JM et al. Gastric polyps: a retrospective analys of 26,000 digestives endoscopies. Arq Gastroenterol. 2007;44:14-7.<\/li>\n\n\n\n
  3. Carmack SW, Genta RM, Schuler CM et al. Am J Gastroenterol. 2009;104:1524-1532.<\/li>\n\n\n\n
  4. Kovari B, Kim BH, Lauwers GY. The pathology of gastric and duodenal polyps: current concepts. Histopathology. 2021;78:106-124.<\/li>\n\n\n\n
  5. Fort\u00e9 E, Petit B, Walter T, et al. Risk of neoplastic change in large gastric hyperplastic polyps and recurrence after endoscopic resection. Endoscopy. 2020;52:444-453.<\/li>\n\n\n\n
  6. Kim Y, Kang S, Ahn J, et al. Risk factors associated with recurrence of gastric hyperplastic polyps: a single-center, long-term, retrospective cohort study. Surgical Endoscopy. 2023;37:7563-7572.<\/li>\n\n\n\n
  7. Bar N, Kinaani F, Sperber AD, et al. Low Risk of Neoplasia and Intraprocedural Adverse Events in Gastric Hyperplastic Polypectomy. J Clin Gastroenterol. 2021;55:851-855.<\/li>\n\n\n\n
  8. Jo\u00e3o M, Areia M, Alves S, et al. Gastric Hyperplastic Polyps: A Benign Entity? Analys of Recurrence and Neoplastic Transformation in a Cohort Study. GE Port J Gastroenterol. 2021;28:328-335.<\/li>\n\n\n\n
  9. Evans JA, Chandrasekhara V, Chathadi KV et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc. 2015;82:1-8.<\/li>\n\n\n\n
  10. Banks M, Graham D, Jansen M et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut. 2019;68:1545-1575.<\/li>\n\n\n\n
  11. Cheesman AR, Greenwald DA, Shah SC. Current Management of Benign Epithelial Gastric Polyps. Curr Treat Options Gastro. 2017;15:676-690.<\/li>\n\n\n\n
  12. Cho YS, Nam SY, Moon HS et al. Helicobacter pylori eradication reduces risk for recurrence of gastric hyperplastic polyp after endoscopic resection. Korean J Intern Med. 2023;38:167-175.<\/li>\n<\/ol>\n\n\n\n

    Como citar este artigo<\/strong><\/h2>\n\n\n\n

    Retes FA. . P\u00f3lipos Hiperpl\u00e1sicos na Endoscopia \u2013 Risco de Neoplasia, Conduta e Recidiva. Endoscopia Terapeutica 2024 vol II. dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/polipos-hiperplasicos-risco-de-neoplasia-conduta-e-recidiva\/<\/a><\/p>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    Os p\u00f3lipos g\u00e1stricos s\u00e3o achados comuns, estando presente em 0,5% a 23% das endoscopias…<\/p>\n","protected":false},"author":5650,"featured_media":19291,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[292],"ano":[742],"tipo":[153],"volume":[147],"class_list":["post-19287","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","tag-endoscopia","ano-742","tipo-endoscopia-digestiva-alta","volume-volume-ii"],"yoast_head":"\nP\u00f3lipos Hiperpl\u00e1sicos na Endoscopia \u2013 Risco de Neoplasia, Conduta e Recidiva • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/polipos-hiperplasicos-na-endoscopia-risco-de-neoplasia-conduta-e-recidiva\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"P\u00f3lipos Hiperpl\u00e1sicos na Endoscopia \u2013 Risco de Neoplasia, Conduta e Recidiva\" \/>\n<meta property=\"og:description\" content=\"Os p\u00f3lipos g\u00e1stricos s\u00e3o achados comuns, estando presente em 0,5% a 23% das endoscopias digestivas altas (1). 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