Abstract

Gastric polyps (GPs) are common luminal lesions of the gastrointestinal tract, frequently detected incidentally in 1–6% of all upper gastrointestinal endoscopy. With the increasing use of endoscopy, the diagnosis of GPs has risen, highlighting the need for a thorough understanding of their pathophysiology and associated cancer risks. This review focuses on epithelial GPs, particularly fundic gland polyps (FGPs), hyperplastic polyps (GHPs) and gastric adenomas (GAs), discussing their classification, epidemiology, histopathology, endoscopic diagnosis, and current management. FGPs are predominantly associated with proton pump inhibitor (PPI) use and are common in regions with low Helicobacter pylori (Hp) prevalence, whereas GHPs are linked with Hp infection and chronic gastritis. GAs, although less common, have a significant risk of malignant transformation, especially in larger lesions. Management strategies vary according to polyp type, size, and dysplastic features, with resection recommended for high-risk lesions. Advances in endoscopic techniques, particularly narrow-band imaging (NBI), offer promising tools for differentiating between polyp types, potentially reducing the need for routine biopsies in the low-risk GPs. This review underscores the role of advanced imaging endoscopic techniques for the accurate classification and individualized management of GPs to mitigate the risk of gastric cancer.