Gastric Polyps: AGA Clinical Practice Update | April 2026

Introduction

Gastric polyps are frequently encountered during upper gastrointestinal endoscopy and represent a heterogeneous group of lesions ranging from benign fundic gland polyps to premalignant adenomas and neuroendocrine tumours. Their clinical significance lies not only in the histologic subtype of the polyp itself but also in the underlying gastric mucosal environment, which may reflect conditions such as Helicobacter pylori infection, autoimmune gastritis, or intestinal metaplasia. The latest update from the American Gastroenterological Association provides a structured, evidence-based approach to the detection, classification, and management of gastric polyps in routine practice.

Problem Statement

Despite their common occurrence, gastric polyps are often managed empirically without a standardised, pathology-driven approach. This can lead to missed underlying mucosal disease, inappropriate surveillance, or unnecessary interventions. There is a need for a clear, lesion-specific and mucosa-oriented strategy to optimise patient outcomes.

Summary

The guideline emphasises that careful endoscopic evaluation should not be limited to the polyp alone but must include systematic assessment of the surrounding gastric mucosa, as this determines both aetiology and management. Biopsy of both the polyp and adjacent mucosa is essential, and resection should be considered based on histologic subtype and risk profile. A key recommendation is universal testing for H. pylori in patients with adenomatous or hyperplastic polyps, as eradication may reduce recurrence and malignancy risk. Importantly, fundic gland polyps associated with proton pump inhibitor use do not require discontinuation of therapy if clinically indicated.

Overall, this update reinforces a mucosa-driven, individualised approach, shifting practice from simple polyp removal to comprehensive gastric disease management.