Retrospective Study Of Endoscopic Diagnosis And Treatment Of Early Gastric Cancer

Objective 1.To compare the effects of Streptomyces proteinase,dyclonine and their combination on improving the visibility of gastroscopic images before gastroscopy;2.To explore the effect of gastroscopy in the diagnosis of Hp infection;3.To explore the safety and effectiveness of endoscopic resection in the treatment of early gastroesophageal junction cancer.Methods 1.158 patients undergoing gastroscopy were randomly divided into four groups:group A（38 cases）,oral administration of Streptomyces proteinase and lidocaine mucilage;group B（32 cases）,oral administration of lidocaine mucilage;group C（47 cases）,oral administration of Streptomyces proteinase and dyclonine mucilage;group D（41 cases）,oral administration of dyclonine mucilage.To observe the visibility score of the mucosa in cardia,fundus,gastric body and antrum and the total visibility score of the four parts,and to carry out urea breath test to analyze the influence of Streptomyces proteinase and dyclonine on the results of the test before gastroscopy.2.Collect the gastroscopy examination in Guangde People’s Hospital in recent six months,and accept ¹⁴C-urea breath test(¹⁴C-UBT)and Helicobacter pylori.210 patients with Helicobacter pylori infection were diagnosed by gastroscopy,and the coincidence rate of Helicobacter pylori infection with serum antibody detection combined with urea breath test was compared.3.Endoscopic submucosal dissection（ESD）was performed in the First Affiliated Hospital of Anhui Medical University in recent three years to treat early gastroesophageal junction cancer.A total of 166 patients were enrolled.The gender,age,ESD treatment,pathology,additional surgical treatment and follow-up data were recorded.Combined with the pathological results,the scores were scored according to the indication classification and eCrua scoring system of endoscopic resection of early gastric cancer.Result 1.The total visibility score of gastric mucosa directly observed by gastroscopy was significantly different among the four groups（p<0.05）.The total visibility score of group C was significantly lower than that of other three groups（p<0.05）.The total visibility score of group B was significantly higher than that of other three groups（p<0.05）.There was no significant difference between group A and group D.There was no significant difference in ¹⁴C-UBT results among the four groups after gastroscopy（p>0.05）.2.The sensitivity,specificity and diagnostic coincidence of gastroscopy in the diagnosis of Hp infection were 90.5%,64.3%and 76.2%,respectively,with ¹⁴C-UBT and Hp antibody IgG as the diagnostic criteria.3.Among 166 patients with early adenocarcinoma of gastroesophageal junction,146（88.0%）were cured after ESD;20cases（12.0%）had non-curable resection,which did not met the treatment criteria,9cases（5.4%）were transferred to perform additional operation.In the non-curable resection group,the proportion of patients with diameter>30 mm,lesions with ulcer or undifferentiated type was higher than that in the curable resection group（P<0.05）.The average follow-up time was 15.7 months（3-33 months）.During the follow-up period,1case had recurrence and no death related to gastric cancer.After operation,there were 4cases of eCura C,2 cases of local residual tumors and 1 case of lymph node metastasis.The scoring results showed that the risk of lymph node metastasis could be assessed by stratification.Conclusion 1.Group C provides the clearest endoscopic field of vision before gastroscopy.Standardized combined application of Streptomyces proteinase and dyclonine before gastroscopy can significantly improve the visibility of gastroscopy images and the detection rate of lesions.It has no effect on the results of ¹⁴C-UBT test,and has good safety and wide application value.2.Diagnosis of Hp infection by gastroscopy can accurately diagnose the status of Hp infection in patients with characteristic mucosal manifestations,which has certain clinical application value.3.ESD is safe and effective for the treatment of early adenocarcinoma of gastroesophageal junction.The eCura score after ESD combined with pathological results can better assess the risk of lymph node metastasis and guide treatment decisions of patients.