We suggest an approach to patients with gastric polyps, based on a study of 73 patients seen at this institution over a 5-year period. There were 40 cases of adenomatous and 20 cases of hamartomatous polyps. Differentiation between these two groups of polyps was not possible on the basis of clinical presentation, laboratory data, radiological, or endoscopic appearance. Differentiation was possible only on histologic examination of a totally resected specimen. In this series, only the adenomatous polyps were associated with gastric cancers in five patients. Since the malignancy either preceded or followed the recognition of adenomatous polyps, it is important to establish an early definite histological diagnosis. Patients with known adenomatous polyps should be followed closely for the development of gastric carcinoma, even after the polyps have been removed.