SUN-640 - Rapid Development of Multiple Fundic Gland Polyps Following GLP-1 Receptor Agonist Therapy: A Case Report

Introduction
The widespread use of glucagon-like peptide-1 (GLP-1) receptor agonists for weight loss and glycemic control has been accompanied by the emergence of novel adverse effects. Gastric polyps are luminal projections exhibiting varying histological aspects and cell origins. Fundic gland polyps (FGP) are the most common gastric polyps identified and are generally attributed to proton pump inhibitor (PPI) use. There is minimal risk of progression to carcinomatosis, and resolution typically requires discontinuation of PPIs. We present a rare case of multiple FGPs in a patient with prolonged use of a GLP-1 agonist, suggesting a possible association between GLP-1 therapy and accelerated polyp development.
Case Presentation
A 60-year-old male presented with multiple episodes of hematemesis and dark-colored stools. Initial management required reversal of apixaban with prothrombin complex concentrate, activation of a massive transfusion protocol, and admission to the ICU. An emergent esophagogastroduodenoscopy (EGD) showed signs of recent bleeding. Multiple polyps were reported in the cardia, fundus, body, greater curvature, lesser curvature, and in the prepyloric region of the stomach.
A tissue biopsy revealed a gastric hyperplastic polyp with focal surface ulceration and moderate chronic active inflammation. The patient underwent a subsequent EGD, in which >10 polyps were resected. Histological examination of these fragments reported acute and chronic inflammation consistent with fundic gland polyps. Immunohistochemistry was negative for H. pylori, intestinal metaplasia, dysplasia, and malignancy.
Further discussion with the patient to establish the etiologies of the gastric polyps determined that he did not have a familial history of polyposis or gastric cancer. The patient used PPIs intermittently for dyspepsia. Moreover, both an EGD and a colonoscopy were performed within the last 3 years without abnormal findings. Finally, the patient initiated GLP-1 agonist therapy two years before the current hospitalization. The patient resumed anticoagulation, was discharged, and scheduled to follow up with Gastroenterology.
Conclusion
The short interval between prior endoscopic evaluations and the emergence of numerous gastric polyps suggests a potential association between GLP-1 agonist use and accelerated development of FGPs. While FGPs are commonly associated with PPI use and have minimal malignant potential, this case raises the possibility of a novel drug-related adverse effect. Further research is warranted to evaluate the relationship between GLP-1 therapy duration and FGP development, as well as any potential contribution to carcinogenesis. Clinicians should be aware of this possible adverse effect, although additional studies are needed to clarify the mechanisms and long-term risks.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*