Not again !!!

I removed this pre-pyloric nodule about a year ago. Histology confirmed an inflammatory/hyperplastic polyp without dysplasia. Now the thing has grown back!?
WHAT IS LIKELY TO BE THE APPROPRIATE MANAGEMENT?

■ Take a full set of biopsies

INCORRECT!

■ Remove the local recurrence by snare

INCORRECT

■ Eradicate the Helicobacters

CORRECT!

EXPLANATION

In most cases, gastric hyperplastic polyps are caused by Helicobacter pylori.  However, because of the 0.6% - 2.1%  risk of cancer arising within a hyperplastic polyp in the stomach, I do remove the larger ones.  However, a year ago, this proved to be a hyperplastic polyp caused by Hp.  The polyp recurred because the underlying cause had not been dealt with.  This patient needs to have his Hp eradicated!! 

A study published in Digestive Diseases & Sciences 2020;65(12):3652-59 confirmed that all 14 patients had complete regression of their hyperplastic gastric polyps 10 months after eradication of their Helicobacter’s compared with none of the 13 patients in the non-eradication group.