| Objective1.To investigate Gastritis Staging and serum pepsinogen for the prediction of gastric cancer risk.And to analyze occurrence of gastric cancer in patients with atrophic gastritis during long-term follow-up,as well as surveillance interval.2.To investigate the correlation between different ranges of gastric mucosa atrophy and histology,and to evaluate the value of different biopsy site combinations in detecting precancerous lesions and assessing the risk of gastric cancer.Methods1.Endoscopic monitoring was performed on the patients with CAG previously diagnosed by endoscopy and confirmed by pathology to be consistent with gland atrophy with or without intestinal metaplasia and low-grade intraepithelial neoplasia(LGIN).Serum pepsinogen and gastrin-17 were determined by enzyme-linked immunosorbency assay(ELISA),and the status of Helicobacter pylori in patients was detected,and scores were scored according to the new gastric cancer screening system.2.Enrolled 116 patients,all patients underwent gastroscopy,under the condition of using pepsin and defoaming agent,high definition white light endoscopic mucosa was thinned,submucosal vessels through see and gastric mucosa color difference,determine the endoscopic atrophic mucosa boundary,by Kimura-Takemoto classification method,the scope of endoscopic gastric mucosa atrophy of parting,at the same time according to the new system of Sydney biopsy standard for histologic biopsy in patients with follow-up.Results1.164 patients with atrophic gastritis were enrolled,averaging age of 57.48±10.71 and male/female 102/62.All patients had been diagnosed with gastric mucosal atrophy or intestinal metaplasia with or without low-grade intraepithelial neoplasia,and the mean follow-up time was 4.2±3.3 years.At least 2 times of monitoring endoscopy were performed.Compared with the low-risk groups with OLGA stage and OLGIM stage,Gastrin-17 was significantly increased in the high-risk group,pepsinogen ratio were significantly decreased,and the difference was statistically significant(P < 0.05).During the follow-up,6 cases of gastric cancer were detected(3.66%),and 4/2 were male/female.Among them,there were 5 cases of early gastric cancer and 1 case of advanced gastric cancer,and the tumor progression rate of chronic atrophic gastritis was0.58% annually.COX regression analysis showed that patients older than 60 years old with atrophic gastritis and low-grade intraepithelial neoplasia were risk factors for the prediction of gastric cancer of atrophic gastritis.2.Among the 116 patients,94 cases of endoscopic diagnosis were completely consistent with histology,with a consistent rate of 81.03%.There was a good agreement between the simplified Kimura-Takemoto classification and the simplified histological classification in the diagnosis of atrophy,and the weighted Kappa value was 0.668(P <0.05).The consistency of OLGA and OLGIM stages in three pathological biopsies(lesser curvature of antral + incisura + lesser curvature of corpus)and the standard pathological biopsies of the new Sydney system was 93.97%(Kappa= 0.912,P<0.05)and 93.10%(Kappa=0.914,P<0.05),respectively.Conclusion1.Chronic atrophic gastritis is a precancerous condition of gastric cancer,and endoscopic follow-up is helpful for early detection of gastric cancer.With the expansion of the scope of atrophic gastritis,the pepsinogen ratio showed a downward trend.Patients with severe atrophic gastritis and low-grade intraepithelial neoplasia over the age of 60 should be surveillanced by endoscopic follow-up at an interval of two years or less.2.Endoscopic grading of atrophic gastritis can predict histological atrophy,and the three pathologic biopsy protocol(lesser curvature of antrum + incisura + lesser curvature of corpus)can be used as routine biopsies for gastric cancer risk screening. |
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