The junction of the esophagus and the stomach is the cardia, and the polyp that grows in the cardia is naturally called cardia polyp (cardiac polyp), and some people’s cardia polyp grows again soon after endoscopic removal, and then cut and grow again, which is scary and always worry about becoming cancerous.
As we can see from the history, the original name of pancreatic polyp is actually called sentinel fold, which refers to the phenomenon of gastric mucosa protruding into the esophagus through the mouth of the cardia to form a fold, just like a sentinel guarding the door, which is especially obvious during the X-barium meal examination. The appearance of the sentinel fold during gastroscopy is very similar to that of general gastrointestinal polyps, so some endoscopists directly called it pancreatic polyps, and gradually, the name of sentinel fold was forgotten as the number of X-barium meal examinations decreased. It can be seen that this so-called cardia polyp is actually just a fold of gastric mucosa that looks like a polyp and is not harmful.
With the widespread availability of gastroscopy and increased vigilance for early cancer, more and more cardia polyps are being detected. American pathologists have summarized and analyzed more than 300 cases of cardia polyps, all of which were benign inflammatory lesions and none of which were neoplastic polyps, the majority of which were gastric mucosal hyperplasia and a few were esophageal mucosal hyperplasia or mixed hyperplasia. Clinical observation also revealed that the proportion of patients with cardia polyps with gastroesophageal reflux symptoms such as heartburn and acid reflux was higher than that of patients without cardia polyps, and many cardia polyps became smaller or even disappeared after antacid treatment. These phenomena suggest that cardia polyps, especially the larger cardia polyps, are caused by acid stimulation of gastroesophageal reflux causing gastroesophageal mucosal hyperplasia, small cardia polyps are often just normal mucosal folds raised, the real tumor of cardia polyps is extremely rare. The above repeatedly cut and grown phenomenon is obviously the cause of uncontrolled gastroesophageal reflux.
To sum up, when pancreatic polyps are found during gastroscopy, biopsy pathology can be done first, and when the result is gastroesophageal mucosal hyperplasia, use acid therapy for a period of time and then review the gastroscopy to determine the effect; when the result is indeed a tumor polyp, it needs to be removed electively endoscopically. It is not inappropriate to remove the whole polyp when it is found and send it for pathological examination. Follow-up is not necessary for pancreatic polyps that have resolved with antacid.
References Melton SD, Genta RM. Gastric cardiac polyps: a clinicopathologic study of 330 cases. Am J Surg Pathol. 2010 Dec;34(12):1792-7. Abraham SC, Singh VK, Yardley JH, Wu TT. Hyperplastic polyps of the esophagus and esophagogastric junction: histologic and clinicopathologic findings. Am J Surg Pathol. 2001 Sep;25(9):1180-7.