Efficacy And Safety Analysis Of Endoscopic Submucosal Dissection In The Treatment Of Gastric Lesions

Objective:To explore the efficacy and safety of endoscopic submucosal dissection(ESD)in the treatment of gastric lesions.Methods:A total of 393 cases of ESD treatment for gastric lesions were collected from the Endoscopy Center of the First Hospital of Lanzhou University from January 2012 to December 2020.We count and analyze patients’ basic information(gender,age,BMI,smoking history,drinking history,family history,comorbidities,liver function,blood coagulation function,platelet count,tumor markers,etc.),gastric lesions’ status(lesion size,lesion location,macroscopic morphology,depth of infiltration,pathological type,etc.),and surgical efficacy and complications(en bloc resection,complete resection,curative resection,postoperative fever,postoperative pneumonia,intraoperative bleeding,postoperative bleeding,etc.),to discuss the the independent risk factors of ESD efficacy and complications.Results:A total of 393 patients were enrolled in this study.The successful resection rate of ESD is 100%(393/393),the en bloc resection rate is 93.9%(369/393),the complete resection rate is 90.8%(357/393),and the curative resection rate is 89.1%(350/393).Among them,35 cases developed postoperative fever,with an incidence rate of 8.9%;9 cases developed postoperative pneumonia,with an incidence rate of 2.3%.All patients’ neumonia improved after treatment and there was no worsening cases;20cases had intraoperative bleeding,with an incidence rate 5.1%,of which 6 cases also had postoperative bleeding;40 cases had postoperative bleeding,the incidence rate was10.2%,of which 29 cases(72.5%)had bleeding within 24 hours after surgery,and 11cases(27.5%)had bleeding within 1 week after surgery,2 out of 40 patients underwent surgical treatment due to poor conservative treatment or endoscopic treatment,and there was no death;2 cases had intraoperative perforation,with an incidence rate of0.51%;2 cases had postoperative perforation,with an incidence rate 0.51%,of which 1case underwent proximal gastrectomy due to poor conservative treatment;most of the complications can be successfully treated by conservative treatment or endoscopic treatment,and there are no other complications such as gastrointestinal stenosis,deep vein thromboembolism,etc.Multivariate regression analysis showed that in terms of the efficacy of ESD treatment,abnormal platelet count(OR: 0.273,95CI: 0.097-0.769,P=0.014)and intraoperative bleeding(OR: 0.236,95CI: 0.064-0.877,P=0.031)are independent risk factors for en bloc resection.Abnormal platelet count(OR: 0.367,95CI:0.145-0.933,P=0.035)and intraoperative bleeding(OR: 0.249,95CI: 0.077-0.802,P=0.02)are independent risk factors for complete resection.Abnormal platelet count(OR: 0.298,95CI:0.124-0.715,P=0.007)and intraoperative bleeding(OR: 0.284,95CI:0.087-0.923,P=0.036)are independent risk factors for curative resection.Multivariate regression analysis showed that in terms of complications of ESD treatment,age≥65 years old(OR: 2.922,95CI: 1.365-6.254,P=0.006),abnormal blood coagulation(OR: 33.180,95CI: 2.868-383.794,P=0.005)and complicated pneumonia(OR: 6.355,95CI: 1.522-26.532,P=0.011)are independent risk factors for postoperative fever.Age≥65 years old(OR: 6.886,95CI: 1.653-28.678,P=0.008)and combined respiratory diseases(OR: 5.915,95CI:1.034-33.824,P=0.046)are independent risk factors for postoperative pneumonia.Abnormal CA199(OR: 7.995,95CI: 1.643-38.910,P=0.010),fragment resection(OR: 5.253,95CI: 1.420-19.429,P=0.013)and neurilemmoma(OR: 12.202,95CI: 1.252-176.716,P=0.033)are independent risk factors for intraoperative bleeding.Intraoperative bleeding(OR: 4.548,95CI: 1.536-13.467,P=0.006)is independent risk factor for postoperative bleeding.Conclusion:1.The en bloc resection rate,complete resection rate,and curative resection rate of ESD are 93.9%,90.8% and 89.1% respectively.The abnormal platelet count and intraoperative bleeding are independent risk factors for en bloc resection,complete resection and curative.2.Age≥65 years old,abnormal blood coagulation function and complicated pneumonia are independent risk factors for postoperative fever;age≥65 years old and combined with respiratory diseases are independent risk factors for postoperative pneumonia;CA199 abnormality,fragment resection and neurilemmoma are independent risk factor for bleeding;intraoperative bleeding is independent risk factor for postoperative bleeding.