Endoscopic treatment strategies for gastric foveolar-type adenoma with a raspberry-like appearance

BACKGROUND/OBJECTIVES: Endoscopic treatment strategies for gastric foveolar-type adenoma with a raspberry-like appearance (GFA-R) have not yet been established. We aimed to clarify the efficacy and safety of endoscopic procedures for GFA-R. METHODS: We extracted GFA-Rs, which were pathologically diagnosed in accordance with WHO classification, at our hospital from January 2009 to December 2023 by endoscopy and retrospectively analyzed their clinicopathological features and endoscopic outcomes. RESULTS: Eighty-eight GFA-Rs were collected from 74 patients. The mean size of GFA-Rs was 4.2 mm (range, 1-10 mm). All lesions demonstrated intramucosal neoplasms without lymphovascular invasion. Endoscopic procedures included only biopsy (n=6), cold forceps polypectomy (CFP; n=42, as outpatient 38/42), cold snare polypectomy (CSP; n=4), endoscopic mucosal resection (EMR; n=36, as inpatient 36/36). The overall en bloc resection rate was 93.9 % (77/82), with rates of 92.9 % (39/42) for CFP, 75.0 % (3/4) for CSP, and 97.2 % (35/36) for EMR, respectively. Lesions smaller than 5 mm were more often treated with CFP while lesions larger than 5 mm were more often treated with EMR. No complications, such as post-operative bleeding or delayed perforation, occurred regardless of the endoscopic procedure. The mean follow-up period was 28.7 months (range, 2-165 months). No local recurrences occurred at 1 year (9-18 months) after an endoscopic procedure for 62 lesions, 2 years (19-30 months) for 40 lesions, and 3 years (31-42 months) for 24 lesions. CONCLUSIONS: These results suggest that endoscopic procedures for GFA-R are effective and safe regardless of the procedure used. Moreover, outpatient CFP may be a simple, useful, and cost-effective endoscopic procedure for GFA-R smaller than 5 mm.