The Correlation Between Endoscopic Grading And Pathological Changes Of Gastric And Duodenal Mucosal Lesions After Radiatherapy

It is a common complication in the treatment of upper abdominal tumors with radiation injury of gastric and duodenal mucosa,such as the radiotherapy of pancreatic cancer,liver cancer and cholangiocarcinoma.Under the endoscopic,the gastroduodenal mucosa with mucosal hyperemia,esema,erosion were observed.Severe lesion include ulcer,perforation,obstruction,gastri retention and so on.The patients with radiotherapy induced lesion appear abdominal pain,dysphagia,abdominal dietension,nausea and vomiting,hematemesis and so on.The pancreas is located in the retroperitoneal,adjacent to the stomach and duodenum.The mucosal of the stomach and duodenum is the most sensitive tissue,less sensitive than bone marrow,and it is vulnerable to lesion.Theradiotherapy induced complication in patient decreased quality of life during therapy and the treatment adherence,and decreased the effectiveness of treatment.We encountered 103 patients with pancreatic cancer during radiotherapy between 2010 and 2016,in General Hospital of the Air Force PLA.We collected the patient’s general information such as gender,age,KPS score,tumor location,tumor size,history of ulcer,surgery history,history of smoking and so on.Self-comparative study of gastroscopic findings was performed on 103 patients with pancreatic cancer who accepted gastroscopy before and after radiotherapy.And to explore the risk factors of radiation injury of stomach and duodenum.The pathological archives of biopsies were taken by gastroscopy and analyzed statistically.Pathological examination revealed the invasion degree of monocytes,neutrophils,eosinophilic granulocyte and the atrophy degree of mucous glands.All the statistical analyses were performed using SPSS22.0 software.P values less than 0.05 were considered to be statistically significant.Correlation analysis were to analysis endoscopic result and mucosal pathology.Single factor analysis,such as T-test,Chisquare test were cued to analyze whether the clinical factors are likely to affect the radition-induced lesion or not.There were13 patients with normal tissue,and the gastric and duodenal mucosa is smooth,no deformation under endoscipic after radiotherapy.13 patients with mucosal hyperemia,swelling and tissue fragility.8 cases with mucosa patchy hemorrhage.9 cases appeared point mucosa erosion,formation of mucosa ulcer in 36 cases,including V grade lesions: ulcer complicated with stenosis in 6 cases,5 cases of duodenal obstruction caused stenosis,simple duodenal stenosis in 5 cases,8 cases of ulcer bleeding.The total incidence rate was 87.4%(90/103),of which gastric and duodenal injury was associated with a total of 53.4%(55/103),gastric mucosal injury was only 34%(35/103),and duodenal injury was only 10.7%(11/103).The pathology was observed mononuclear cell infiltration degree(4 cases VS29 cases VS34 cases VS36 cases),the degree of neutrophil infiltration(48 cases VS24 cases VS20 cases VS11 cases),eosinophil infiltration(68 cases VS24 cases VS8 cases VS3 cases)and gastric and duodenal mucosa atrophy(24 cases of VS33 VS29 cases VS17 cases).Endoscopic findings had obviously positive correlation with the invasion degree of monocytes,neutrophils,eosinophilic granulocyte and the atrophy degree of mucous glands(r=0.466,p=0.000;r=0.434,p=0.000;r=0.274,p=0.05;r=0.480,p=0.000).Additionally,the positive correlation showed between endoscopic findings and the symptom(r=0.421,p=0.000).The age factor had influence on the grade of mucosal lesion(P=0.023).Conclusion: 1.Endoscopic findings and pathological is positively related with pathological grade increased,and increased gradually,in the invasion degree of monocytes,neutro-phils,eosinophilic granulocyte and the atrophy degree of mucous glands.2.The grading of lesionis positively correlated with clinical symptoms,and the clinical symptoms are more severe with the aggravation of grading.According to the clinical symptoms of patients,may be appropriate to give digestive enzymes and promote gastrointestinal motility drugs,improve symptoms of indigestion.3.There is no effect of radiochemotherapy on radiation-induced injury of stomach and duodenum,and the patients could be treated with concurrent chemoradiotherapy according to the patient’s condition.4.There is no effect on the radiation-induced injury and the grade of lesion,but the proton pump inhibitor has effect on the radiation-induced ulcer.5.The radiotherapy methods can lead to radiation gastrointestinal injury,according to the location of the tumor,clinical stage and the economic conditions of patients to choose appropriate radiotherapy methods.6.Patients with pancreatic cancer during radiotherapy should undergo regular gastroscopy to avoid complications such as ulcer,perforation,obstruction,bleeding,and improve the quality of life of patients.