{"id":4651,"date":"2019-08-27T10:00:47","date_gmt":"2019-08-27T10:00:47","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/assuntos-gerais-polipos-de-gladulas-fundicas\/"},"modified":"2022-05-26T23:51:34","modified_gmt":"2022-05-26T23:51:34","slug":"assuntos-gerais-polipos-de-gladulas-fundicas","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/assuntos-gerais-polipos-de-gladulas-fundicas\/","title":{"rendered":"Assuntos Gerais : P\u00f3lipos de Gl\u00e2dulas F\u00fandicas"},"content":{"rendered":"

Os p\u00f3lipos g\u00e1stricos ocorrem em cerca de 6% das endoscopias digestivas altas nos EUA, sendo os P\u00f3lipos de Gl\u00e2ndulas F\u00fandicas (PGF) mais comuns. Estudo retrospectivo de 2008, mostra que em 121.564\u00a0 endoscopias realizadas em cl\u00ednicas privadas de 36 estados americanos, atestaram um total de 6,35% de presen\u00e7a de p\u00f3lipos, destes, 77% PGF, 17% hiperpl\u00e1sicos e cerca de 0,7% de adenomas.<\/p>\n

Em sua grande maioria, os PGF s\u00e3o achados de exame. Mais comumente presente em mulheres de meia idade, tipicamente s\u00e3o s\u00e9sseis, pequenos, de tamanho variando entre 3 e 8mm (em m\u00e9dia 5mm), podendo ser \u00fanicos ou m\u00faltiplos, na maioria das vezes localizados no corpo g\u00e1strico. Sua apar\u00eancia \u00e9 cl\u00e1ssica, recoberta por mucosa foveolar normal, o que facilita sua identifica\u00e7\u00e3o pela maioria dos endoscopistas. Por\u00e9m, a an\u00e1lise histopatol\u00f3gica deve ser sempre realizada, confirmando o achado.<\/p>\n

\"\"<\/a>\"\"<\/a>\"\"<\/a>\"\"<\/a><\/p>\n

O PGF microscopicamente consiste em gl\u00e2ndulas ox\u00ednticas f\u00fandicas dilatadas revestidas por c\u00e9lulas parietais \u00a0ou mucosas achatadas.<\/p>\n

\"\"<\/a> \"\"<\/a><\/p>\n

A maioria dos PGF s\u00e3o espor\u00e1dicos, por\u00e9m podem estar associados a Polipose Adenomatosa Familiar (PAF) e polipose associado a MUTYH, chamados ent\u00e3o de sindr\u00f4micos. Pacientes com FAP podem apresentar PGF em\u00a020 a 100% dos casos.<\/p>\n

A presen\u00e7a de displasia \u00e9 extremamente rara nos casos de PGF espor\u00e1dicos. Estudo retrospectivo com 35.000 PGF espor\u00e1dicos demonstrou achado de displasia de baixo grau em 0,3%, e mais raro ainda as de alto grau (displasia eram mais comuns nos p\u00f3lipos acima de 10 mm). N\u00e3o h\u00e1 descri\u00e7\u00e3o de evolu\u00e7\u00e3o para c\u00e2ncer g\u00e1strico.<\/p>\n

N\u00e3o \u00e9 poss\u00edvel a distin\u00e7\u00e3o endosc\u00f3pica entre os p\u00f3lipos espor\u00e1dicos e os sindr\u00f4micos, por\u00e9m, os sindr\u00f4micos surgem de muta\u00e7\u00f5es no gene da beta catenina, uma muta\u00e7\u00e3o caracter\u00edstica do gene APC, e nesses casos, h\u00e1 displasia em cerca de 25 a 62% dos p\u00f3lipos. Assim, em endoscopia com achado de grande quantidade de p\u00f3lipos, principalmente em jovens sem uso de inibidores de bomba de pr\u00f3tons (PPI) e na presen\u00e7a de displasia, deve levantar a suspeita para Polipose Adenomatosa Familiar, e o paciente investigado.<\/p>\n

H\u00e1 associa\u00e7\u00e3o importante com uso de PPI. Estudo recente demonstrou que o uso de PPI por mais de 5 anos aumenta o risco de PGF em at\u00e9 4 vezes, e a suspens\u00e3o do uso de PPI pode regredir o quadro. Esta rela\u00e7\u00e3o aparentemente \u00e9 devido ao aumento da gastrina circulante e hiperplasia das c\u00e9lulas enterocromafins, o que tamb\u00e9m explicaria o achado de PGF em casos de gastrinoma.<\/p>\n

CONSIDERA\u00c7\u00d5ES<\/strong><\/p>\n

Como j\u00e1 descrito o achado de PGF \u00e9 incidental, em pacientes com sintomas diversos do trato gastro intestinal que realizam endoscopia, n\u00e3o havendo sintoma ou sinal caracter\u00edstico. Est\u00e1 indicada sempre a ressec\u00e7\u00e3o de alguns p\u00f3lipos<\/a> para avalia\u00e7\u00e3o e confirma\u00e7\u00e3o histol\u00f3gica, de prefer\u00eancia os ulcerados, maiores que 10mm, ou locados em\u00a0antro. A possibilidade de PAF dever ser admitida em pacientes com mais de 20 p\u00f3lipos, p\u00f3lipos em antro, concomitantes com adenomas de duodeno<\/a>, sendo indicada a colonoscopia.<\/p>\n

Se a an\u00e1lise anatomopatol\u00f3gica n\u00e3o indicar displasia, n\u00e3o est\u00e1 indicada vigil\u00e2ncia endosc\u00f3pica ap\u00f3s a primeira endoscopia, nem a retirada de todos os p\u00f3lipos. Se poss\u00edvel deve ser cessado o uso de PPI . Quando h\u00e1 achado de displasia, apesar de n\u00e3o haver consenso, pode-se repetir endoscopia a cada ano, ou se n\u00e3o houve retirada total da les\u00e3o ou presen\u00e7a de displasia de alto grau, nova endoscopia em seis meses deve ser realizada. Estes intervalos parecem ser adequados dado a lenta evolu\u00e7\u00e3o deste tipo de les\u00e3o, sendo descrito que a recorr\u00eancia ocorre em m\u00e9dia ap\u00f3s cerca de 35 meses. Caso exista rela\u00e7\u00e3o com PAF, a doen\u00e7a intestinal dita a conduta.<\/p>\n

BIBLIOGRAFIA :<\/p>\n

Tran-Duy A, Spaetgens B, Hoes AW, de Wit NJ, Stehouwer CD. Use of Proton Pump Inhibitors and Risks of Fundic Gland Polyps and Gastric Cancer: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2016 Dec;14(12):1706-1719.e5.<\/a><\/p>\n

Cheesman AR, Greenwald DA, Shah SC. Current Management of Benign Epithelial Gastric Polyps. Curr Treat Options Gastroenterol. 2017 Dec;15(4):676-690.\u00a0<\/a><\/p>\n

\u00a0Freeman HJ. Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis. World J Gastroenterol. 2008 Mar 7;14(9):1318-20.\u00a0<\/a><\/p>\n

Saiba tamb\u00e9m sobre:<\/strong> Hiperplasia foveolar<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Os p\u00f3lipos g\u00e1stricos ocorrem em cerca de 6% das endoscopias digestivas altas nos EUA,…<\/p>\n","protected":false},"author":2221,"featured_media":5313,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[145],"tipo":[153],"volume":[147],"class_list":["post-4651","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-145","tipo-endoscopia-digestiva-alta","volume-volume-ii"],"yoast_head":"\nAssuntos Gerais : P\u00f3lipos de Gl\u00e2dulas F\u00fandicas • 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\/assuntos-gerais-polipos-de-gladulas-fundicas\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Assuntos Gerais : P\u00f3lipos de Gl\u00e2dulas F\u00fandicas\" \/>\n<meta property=\"og:description\" content=\"Os p\u00f3lipos g\u00e1stricos ocorrem em cerca de 6% das endoscopias digestivas altas nos EUA, sendo os P\u00f3lipos de Gl\u00e2ndulas F\u00fandicas (PGF) mais comuns. 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Especialista em Cirurgia do Aparelho Digestivo (HCFMUSP), Endoscopia Digestiva (SOBED) e Gastroenterologia (FBG). Professor do curso de Medicina da Funda\u00e7\u00e3o Educacional do Munic\u00edpio de Assis - FEMA. 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