Published online Nov 14, 2026. doi: 10.3748/wjg.120663
Revised: April 1, 2026
Accepted: May 6, 2026
Published online: November 14, 2026
Processing time: 201 Days and 15.3 Hours
Inflammatory fibroid polyps (IFPs) are rare lesions of the gastrointestinal tract. Knowledge regarding the endoscopic and clinical characteristics of IFPs remains limited.
To investigate the clinical and endoscopic characteristics of IFPs and evaluate the outcomes of endoscopic resection (ER) for IFP management.
This retrospective analysis enrolled a consecutive cohort of patients who received ER for IFPs at our institution between March 2014 and December 2024. We collected and analyzed their clinicopathological characteristics, endoscopic findings, and long-term follow-up outcomes.
A total of 108 consecutive patients were included (59 females, 54.6%), with a mean age of 54.6 ± 10.7 years. The median lesion size was 10 mm (range 5-50 mm). Most lesions were located in the stomach (70/108, 64.8%), followed by the large intestine (36/108, 33.3%); one lesion was found in the esophagus and one in the duodenum. All 108 patients successfully underwent ER, with no severe adverse events reported. Both the en bloc resection rate and the endoscopic complete resection rate were 99.1%. Three of 108 patients (2.8%) developed recurrent lesions postoperatively. A comparative analysis of gastric and colorectal IFP patients revealed significant differences in lesion size, endoscopic techniques, and operative time. One case of early gastric cancer coexisting with IFP was identified.
IFPs lack specific clinical manifestations and endoscopic findings. ER is safe and effective for the management of IFP, avoiding the need for surgery.
Core Tip: Inflammatory fibroid polyps (IFPs) are rare gastrointestinal mesenchymal lesions with non-specific clinical and endoscopic features. This largest single-center cohort study of endoscopically treated IFPs confirms that ER is a safe and effective first-line treatment for IFPs, with high en bloc and complete resection rates. IFPs also show no specific features under endoscopic ultrasonography. Gastric IFPs tend to be larger and require more complex endoscopic resection techniques than colorectal IFPs.
- Citation: Wang CH, Liu F, Ji XH, Li LS, Chai NL. Clinical characteristics and endoscopic management of inflammatory fibroid polyp of the gastrointestinal tract. World J Gastroenterol 2026; 32(42): 120663
- URL: https://www.wjgnet.com/1007-9327/full/v32/i42/120663.htm
- DOI: https://dx.doi.org/10.3748/wjg.120663
Inflammatory fibroid polyp (IFP), initially termed “eosinophilic granuloma” by Vanek[1] in 1949, is an uncommon benign mesenchymal neoplasm occurring in the gastrointestinal (GI) tract. It is characterized by spindle cell proliferation, eosinophilic infiltration, and a rich vascular network within a myxoid stroma[1,2]. The epidemiology of IFP remains poorly defined due to their rarity, with an estimated prevalence of 0.1% among all gastric polyps[3].
IFP has many different clinical manifestations, ranging from asymptomatic incidental findings during routine endoscopy to severe complications such as abdominal pain, intestinal obstruction, or GI bleeding, depending mainly on location, size, and anatomical relationship to adjacent structures[4,5].
Endoscopic features of IFPs are diverse, and it needs to be differentiated from various submucosal or mucosal lesions, which makes it prone to missed diagnosis and misdiagnosis[6]. In the present study, we described and analyzed the clinical symptoms, endoscopic findings, endoscopic ultrasonography (EUS) features, treatment, and prognosis of IFPs based on our 10-year experience to provide references for clinical diagnosis and management.
The study was retrospectively carried out at the GI Endoscopy Center of the Chinese PLA General Hospital. From March 2014 to December 2024, patients who underwent endoscopic resection (ER) and were pathologically confirmed IFP were enrolled. Exclusion criteria: (1) Patients with unclear medical records that did not describe the location, quantity, size, shape, and treatment methods of IFP; and (2) Patients lost to follow-up. Written or oral informed consent was obtained from all patients. Oral consent was completed by telephone for some participants. The study was approved by the Ethics Committee at PLA General Hospital, approval No. S2023-115-01.
We retrospectively analyzed data from our institutional database and medical records, including demographics, lesion features (size, location, morphology, growth pattern and ulceration), number of leisons (single or multiple), en bloc resection, adverse events, and follow-up. Morphology was classified according to the Yamada system. En bloc resection was defined as removal of the tumor in a single piece. Endoscopic complete resection referred to en bloc resection with no endoscopic evidence of residual lesion. Adverse events were evaluated using criteria from the American Society for GI Endoscopy[7].
Four ER techniques were used: Cold snare polypectomy (CSP), hot snare polypectomy (HSP), endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD). Generally speaking, CSP was used for small and sessile lesions with a diameter 5-10 mm. HSP was adopted for protruding lesions with long and thick peduncles. In HSP, the base of the lesion was tightened by an endoloop with the aim of wound closure. Then, the lesion was resected with a snare cautery. Preprocedural EUS (Olympus, Tokyo, Japan) was performed to evaluate the layer of origin, echogenicity, and growth pattern of lesions before ESD and EMR. EMR and ESD were applied to broad-based sessile lesions. For EMR, a mixture of saline, 1:10000 epinephrine, and indigo carmine was injected into the submucosa to lift the lesion from the muscularis propria, followed by hot snare resection. In ESD, circumferential marking was first performed using a dual knife (Olympus). Submucosal injection was identical to that in EMR, and complete resection was achieved by careful submucosal dissection using a dual knife or insulated-tip knife (Olympus).
Patients underwent follow-up endoscopy at 3-6 months after resection, followed by endoscopic surveillance every 1-2 years to assess wound healing and screen for residual tumor, recurrence, or metastasis.
Statistical analysis was performed using SPSS software, version 27.0 (SPSS, Chicago, IL, United States). Normally distributed data were presented as mean ± SD and compared using independent t-tests. Non-normally distributed data were expressed as median (range) and analyzed with the Mann-Whitney U test. Categorical variables were reported as frequencies and compared using the χ2 test or Fisher’s exact test. Given the distinct anatomical structure between the stomach and colorectum, univariate analysis was performed to compare gastric and colorectal IFPs, aiming to explore site-specific ER strategies for IFPs. In addition, univariate analysis was conducted to identify factors associated with large lesion size (≥ 20 mm). Statistical significance was indicated by a P value < 0.05.
In total, 108 patients were included in our study. The clinicopathological characteristics of the 108 patients are summarized in Table 1. There were 49 men and 59 women, with a mean age of 54.6 ± 10.7 years. Most patients were asymptomatic (75/108, 69.4%) while those with symptoms presented with epigastric pain (12/108, 11.1%), epigastric discomfort or abdominal distention (10/108, 9.3%), melena or occult blood in feces (5/108, 4.6%), loss of appetite (2/108, 1.9%), nausea (2/108, 1.9%), and vomiting (2/108, 1.9%). The median lesion size was 10 mm (range, 5-50 mm). The majority of the lesions were located in the stomach (70/108, 64.8%), with the antrum (53/108, 49.1%) being the most common site, followed by the large intestine (36/108, 33.3%). Additionally, 1 case was found in the esophagus (lesion size: 50 mm; Figure 1), and 1 case in the duodenum (lesion size: 20 mm; Figure 2). A total of 101 patients had a single lesion, whereas 7 had multiple lesions, with 118 lesions in total. Yamada type I was the predominant morphological type (62, 52.5%), followed by type II (33, 28.0%), type IV (12, 10.2%), and type III (11, 9.3%). Local erosion or ulceration was present in 28 lesions.
| Characteristics | Values |
| Patients | 108 |
| Age (year), mean ± SD | 54.6 ± 10.7 |
| Gender, female | 59 (54.6) |
| Symptoms | |
| Asymptomatic | 75 (69.4) |
| Epigastric pain | 12 (11.1) |
| Epigastric discomfort or abdominal distension | 10 (9.3) |
| Melena or occult blood in feces | 5 (4.6) |
| Loss of appetite | 2 (1.9) |
| Nausea | 2 (1.9) |
| Vomiting | 2 (1.9) |
| Lesion size, mm, median (range) | 10 (5-50) |
| Lesion location | |
| Stomach | 70 (64.8) |
| Cardia | 6 (5.6) |
| Corpus | 9 (8.3) |
| Fundus | 1 (0.93) |
| Angular incisure | 1 (0.93) |
| Antrum | 53 (49.1) |
| Esophagus | 1 (0.93) |
| Duodenum | 1 (0.93) |
| Large intestine | 36 (33.3) |
| Cecum | 2 (1.9) |
| Ascending colon | 5 (4.6) |
| Transverse colon | 6 (5.6) |
| Descending colon | 2 (1.9) |
| Sigmoid colon | 10 (9.3) |
| Rectum | 11 (10.2) |
| Morphology | 118 |
| Type I | 62 (52.5) |
| Type II | 33 (28.0) |
| Type III | 11 (9.3) |
| Type IV | 12 (10.2) |
| Surface erosion or ulcerations | 28 (25.9) |
| Number of lesion | |
| Single | 101 (93.5) |
| Multiple | 7 (6.5) |
EUS was performed in 31 patients (28.7%). All lesions showed an intraluminal growth pattern. EUS demonstrated that 18 lesions originated from the mucosal layer and 13 from the submucosal layer. In terms of echogenic features, 25 lesions were hypoechoic and 6 were hyperechoic; additionally, 10 lesions exhibited a heterogeneous internal echotexture.
ER was successfully performed in 108 patients. Clinical outcomes of ER for IFPs are summarized in Table 2. CSP, HSP, EMR, and ESD were performed in 19 patients, 45 patients, 11 patients, and 32 patients, respectively. In addition, one patient with a submucosal lesion at the cardia underwent submucosal tunneling endoscopic resection (STER). The median procedure time was 8 minutes (range, 3-120 minutes). En bloc resection was accomplished in 107 patients (99.1%), with only one large lesion resected piecemeal. The overall rate of endoscopic complete resection was 99.1%. No severe adverse events such as delayed bleeding or perforation occurred. Three patients developed transient postoperative fever (max 38.3 °C, 38.5 °C, 39.1 °C) on postoperative day 1, which resolved spontaneously with conservative treatment. Postoperative pathology identified one case of IFP concomitant with early gastric cancer (Figure 3).
| Outcomes | Values |
| Endoscopic treatment | |
| CSP | 19 (17.6) |
| HSP | 45 (41.2) |
| EMR | 11 (10.2) |
| ESD | 32 (29.6) |
| STER | 1 (0.9) |
| Success rate | 100 (108) |
| Operation time, minutes, median (range) | 8 (3-120) |
| En bloc resection | 107 (99.1) |
| Endoscopic complete resection | 107 (99.1) |
| Adverse events | |
| Fever | 3 (2.7) |
| Delayed bleeding | 0 |
| Perforation | 0 |
| Follow-up, months, median (range) | 50 (8-124) |
| Recurrence rate | 3 (2.8) |
Table 3 presents a comparative analysis of patients with gastric IFP and colorectal IFP. The analysis revealed that age, gender, and the proportion of symptomatic patients were comparable between the 2 groups. Lesion size differed significantly between the two groups (P = 0.004). In the gastric IFP group, 25.7% of lesions were ≥ 20 mm, whereas only 2.8% of colorectal IFP lesions reached this size. Endoscopic treatment modalities also varied markedly between groups (P < 0.001). ESD was used in 38.6% of gastric IFP cases but only 8.3% of colorectal cases. In contrast, CSP was far more common in colorectal IFP (38.9%) than in gastric IFP (7.1%). Additionally, the operation time was significantly longer in the gastric IFP group [12 minutes (range: 5-120)] compared to the colorectal IFP group [4.5 minutes (range: 3-30)] (P < 0.001).
| Variables | Gastric IFP group (n = 70) | Colorectal IFP group (n = 36) | P value |
| Age (year), mean ± SD | 55.5 ± 9.8 | 52.9 ± 12.5 | 0.238 |
| Gender, female | 42 (60) | 16 (44.4) | 0.128 |
| Symptomatic | 25 (35.7) | 7 (19.4) | 0.084 |
| Lesion size, mm | 0.004 | ||
| < 20 mm | 52 (74.3) | 35 (97.2) | |
| ≥ 20 mm | 18 (25.7) | 1 (2.8) | |
| Endoscopic treatment | < 0.001 | ||
| CSP | 5 (7.1) | 14 (38.9) | |
| HSP | 28 (40) | 17 (47.2) | |
| EMR | 9 (12.9) | 2 (5.6) | |
| ESD | 27 (38.6) | 3 (8.3) | |
| STER | 1 (1.4) | 0 | |
| Operation time, minutes, median | 12 (5-120) | 4.5 (3-30) | < 0.001 |
Univariate analysis was performed to identify factors associated with large IFP lesions (≥ 20 mm). The results are summarized in Table 4. Age, gender, and surface erosion or ulceration were not significantly associated with lesion size (all P > 0.05). Lesion location was significantly associated with large lesions: Upper GI tract lesions were more likely to be ≥ 20 mm compared with colorectal lesions (P = 0.002). In addition, complex endoscopic treatment (EMR/ESD/STER) was significantly more frequently performed for large IFPs, whereas simple polypectomy (CSP/HSP) was more common for smaller lesions (P = 0.001).
| Variables | Categories | Lesion size ≥ 20 mm | Lesion size < 20 mm | P value |
| Age (year), mean ± SD | - | 56.2 ± 9.8 | 54.3 ± 10.9 | 0.497 |
| Gender | Male | 9 (42.9) | 40 (46.0) | 0.797 |
| Female | 12 (57.1) | 47 (54.0) | ||
| Lesion location | Upper GI tract (esophagus, stomach, duodenum) | 20 (95.2) | 52 (59.8) | 0.002 |
| Colorectum | 1 (4.8) | 35 (40.2) | ||
| Surface erosion/ulceration | Yes | 5 (23.8) | 23 (26.4) | 0.805 |
| No | 16 (76.2) | 64 (73.6) | ||
| Endoscopic treatment | Simple (CSP/HSP) | 6 (28.6) | 58 (66.7) | 0.001 |
| Complex (EMR/ESD/STER) | 15 (71.4) | 29 (33.3) |
In our study, the median follow-up duration was 50 months (range, 8-124 months). Most symptomatic patients achieved substantial symptom relief following ER. Three patients experienced recurrence at 96 months, 24 months, and 12 months (Figure 4) postoperatively, respectively. Table 5 provides detailed information on these three patients.
| Number | Gender | Age (year) | Lesion location | Lesion size (mm) | Morphology | Surface erosion or ulcerations | ER techniques | Recurrence time (month) |
| Patient 1 | Female | 41 | Gastric antrum | 20 | Type I | None | EMR | 96 |
| Patient 2 | Male | 49 | Gastric antrum | 18 | Type I | None | ESD | 24 |
| Patient 3 | Female | 53 | Gastric antrum | 20 | Type I | None | ESD | 12 |
Our study, including 108 cases, represents the largest single-center cohort of endoscopically resected IFPs to date. Sánchez et al[8] reported 67 IFP cases, and Chi et al[9] reported 114 cases. However, both studies included a mixture of endoscopic and surgical patients, with 22.4% and 18.9% undergoing surgical resection, respectively. A systematic review by Garmpis et al[10] summarized 417 total IFP cases, but only 20.4% were treated endoscopically. In contrast, our study focused only on ER, providing a more homogeneous population for outcome analysis. The main new findings of our study are as follows: First, we compared the differences between gastric and colorectal IFPs in detail; second, we provided long-term follow-up data on recurrence after ER; third, we analyzed the clinical features and safety of ER in a large pure endoscopic cohort.
IFP is an uncommon benign mesenchymal tumor occurring throughout the GI tract[6]. It predominantly affects middle-aged individuals in the fifth decade of life and shows a female predominance[5,10]. In our cohort, the female-to-male ratio was 59:49, with a mean age of 54.6 years. The stomach was the most frequently involved site. While some literature states that the small intestine as the second most common location, our findings indicate that the colon is the second most common location, which is consistent with the conclusions reported in a retrospective article[8]. Unfortunately, our endoscopy center did not identify any cases of small intestinal IFPs. This discrepancy may be attributed to the high frequency of colorectal cancer screening in our setting, as well as the focus of most relevant literature reviews on IFP-induced intestinal intussusception[11-13]. Additionally, an IFP in the small intestine is more likely to be detected via computed tomography scans or surgical procedures and removed through surgery, rather than identified and excised using endoscopic examinations[11,14]. 69.4% of IFPs were asymptomatic and identified incidentally. The most frequent manifestations were epigastric pain, abdominal distension, melena, or fecal occult blood, consistent with previous reports on IFPs[10,14,15].
Diagnosis of IFP relies on pathological examination combined with immunohistochemistry as the gold standard[16]. IFPs are variably positive for vimentin and usually positive for CD34, but negative for CD117, S-100 calcium binding protein and pan-cytokeratin[4,6,17,18]. Most IFPs bear platelet-derived growth factor receptor alpha mutations[15]. These findings provide valuable evidence for distinguishing IFPs from other mesenchymal tumors, such as GI stromal tumor, inflammatory myofibroblastic tumor, hamartomatous polyps, solitary fibrous tumor, leiomyoma, and nerve sheath tumors[6,19]. However, preoperative diagnosis of IFP remains difficult. Imaging features on computed tomography, magnetic resonance imaging and endoscopy are typically nonspecific, and conventional endoscopic biopsies often yield false-negative results owing to the overlying mucosa[20]. Although IFPs have typical manifestations under EUS which are characterized by a hypoechoic homogeneous lesion, and location within the second and/or third echolayer[14,21]. Our study results showed that among the 31 patients who underwent EUS, 6 lesions were hyperechoic; additionally, 10 lesions exhibited heterogeneous internal echotexture. This observation is supported by other research. Matsushita et al[21] analyzed the EUS features of 10 pathologically confirmed IFP cases and found hyperechoic or heterogeneous internal echoes in 2 of these cases. Similarly, Peng et al[22] reported a case of an esophageal IFP, whose EUS feature showed hyperechogenicity without significant internal blood flow signal. Therefore, IFPs also show no specific features under EUS.
ER is regarded as a safe and effective approach for IFPs, enabling accurate histologic diagnosis and radical resection. Accumulating evidence has also supported the safety and feasibility of ER in managing IFPs[8,10,14]. Garmpis et al[10] conducted a systematic review on IFPs and identified 85 patients with IFP who successfully underwent ER. Wang et al[14] retrospectively analyzed 9 patients diagnosed with IFPs and reported that 6 of these patients underwent successful ER, with 3 receiving EMR and the other 3 undergoing ESD. No severe complications were observed in these patients. During a mean follow-up period of 4.9 years, only one patient with a rectal IFP experienced recurrence and subsequently underwent endoscopic full thickness resection. In another retrospective study of 67 patients, ER was successfully performed in 52 cases (77.6%), and no recurrence was observed during a long follow-up period with a median of 68.3 months (range: 11-136 months)[8]. In our study, the endoscopic complete resection rate reached 99.1%, with no serious adverse events observed. During a long-term follow-up period with a median of 50 months (range: 8-114 months), recurrence was noted in 3 (2.8%) patients. All recurrent lesions in these 3 patients were located in the gastric antrum: One patient who underwent EMR experienced recurrence 8 years post-resection, while the other two patients who received ESD had recurrence at 1 year and 2 years post-resection, respectively.
We tend to believe that ER is a safe and effective method for IFPs. However, surgical intervention remains necessary in certain specific scenarios: (1) IFPs situated in specific locations (e.g., the small intestine or appendix); (2) IFPs that result in digestive tract complications, namely intussusception or obstruction; and (3) Giant-sized IFPs. Even though in our study, the maximum diameter of the lesions reached 50 mm. Peng et al[22] previously reported a case of an esophageal IFP (measuring 55 mm × 19 mm) that was successfully resected via ESD without any complications. Wang et al[2] further provided evidence of ESD’s efficacy in managing larger IFPs, documenting a case of a gastric antrum IFP (73 mm × 33 mm × 20 mm) that was also resected successfully via ESD without complications.
Notably, the biological characteristics of IFPs have not been fully clarified. Our study included one patient with early gastric cancer concomitant with an IFP, who was treated by ESD. Pathological findings showed moderately to poorly differentiated adenocarcinoma at the gastric antrum’s lesser curvature: The cancer was confined to the mucosal layer with focal invasion of the muscularis mucosae, and an IFP was detected in the submucosa. Two additional studies have also documented concurrent cases of IFP and adenocarcinoma. In these two instances, the adenocarcinomas were well-differentiated and invaded the mucosal or submucosal layer, while the IFPs were consistently located beneath or at the adenocarcinomas’ edge[23,24].
Several limitations should be acknowledged. First, this was a single center retrospective study, and possible bias could not be eliminated. A multicenter trial with a larger number of patients should be conducted. Second, due to the unique characteristics of small intestinal lesions, our GI center lacks cases of small intestinal IFP resected under endoscopy. Third, the limited number of recurrence events (n = 3) restricted statistical power to identify potential risk factors for recurrence. Further largescale studies with extended follow up are warranted to identify risk factors for IFP recurrence.
IFP lacks specificity in its clinical manifestations, endoscopic findings, and EUS features. On EUS, lesions may be hypoechoic, hyperechoic, or exhibit heterogeneous echotexture. ER is a safe and valuable strategy for managing IFP, avoiding the need for surgery. Gastric and colorectal IFP patients differ significantly in lesion size, endoscopic treatment approaches, and operation time. Univariate analysis further confirmed that lesion location was associated with large IFPs (≥ 20 mm), with upper GI lesions more likely to be larger than colorectal lesions. In addition, larger lesions were more frequently treated with complex endoscopic procedures (EMR/ESD/STER). These differences may inform tailored clinical management strategies for IFP based on anatomical location. Furthermore, the biological behavior of IFPs remains to be further elucidated.
The authors thank all the patients and medical staff involved in this study for their contributions.
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