Analysis Of The Related Factors Affecting Endoscopy Detection Rate Of Intraepithelial Neoplasia And Early Gastric Cancer

Objective To study the difference of clinical and endoscopic features between gastric mucosal intraepithelial neoplasia(GIN)and early gastric cancer(EGC),provide the basis for improving the detection rate of EGC by endoscopic biopsy.To compare the influence of different states of H.pylori infection on endoscopic diagnosis of GIN and EGC,and analyze the related factors.To analyze the advantages of magnif ying endoscopy with narrow-band imaging(ME-NBI)in the diagnosis of gastric cancer under different infection states of H.pylori.Methods A total of 151 patients with low-grade intraepithelial neoplasia(LGIN),high-grade intraepithelial neoplasia(HGIN)or EGC were selected from January2014 to June 2022 in our hospital for pathological biopsy.the H.pylori infection status,sex,age,location,morphological type,size of lesions and endoscopic images were collected.Firstly,the clinical and gastroscopic features of LGIN,HGIN or EGC were compared;then,according to the endoscopic diagnosis,whether the status of H.pylori infection affected the consistency of endoscopic diagnosis and pathological results was analyzed,and analysis the factors affecting the endoscopic detection rate under different H.pylori infection status;finally,endoscopic images of differ ent H.pylori infection states were selected to analyze the characteristics of LGIN,HGIN or EGC lesions under ME-NBI,and to evaluate the advantages of ME-NBI over WLE.Results 1.Age,location,shape and size of lesions were related to endoscopic biopsy diagnosis,in terms of age,patients<60 years old accounted for a large proportion in the LGIN group,and patients≥60 years old accounted for a large proportion in the HGIN+EGC group(X~2=7.816,P=0.005),in terms of lesion location,the lower part o f the stomach was more in the LGIN group,and the middle part of the stomach was more in the HGIN+EGC group(X2=14.180,P=0.001),in terms of morphology,the non-sunken type was more in the LGIN group and the sunken type in the HGIN+EGC group(X2=17.757,P<0.001),in terms of size,the proportion of lesions≤1cm was more in LGIN group,and that of 1<diameter≤2 was more in HGIN+EGC group(X2=15.524,P<0.001).The four related factors were included in the multi-factor logistic regression model for analysis.Age(OR=2.181,95%CI:1.013～4.697,P=0.046),lesion shape(OR=3.921,95%CI:1.748～8.794,P=0.001),lesion size(1 cm<diameter≤2cm vs≤1cm:OR=4.988,95%CI:1.919～12.968,P=0.001)(>2cm vs≤1cm:OR=4.659,95%CI:1.640～13.237,P=0.004)were independent risk factors for endoscopic biopsy pathological diagnosis.while sex and H.pylori infection status had no significant statistical significance(P>0.05).2.Under different infection states of H.pylori,there was no significant difference in clinicopathological features in terms of age,sex,location and size of lesions(P>0.05),but in terms of lesion morphology,non-sunken type was more common in H.pylori negative group and post-eradication group,and sunken type was more common in positive group(P=0.021).The consistency between endoscopic diagnosis and pathological results:negative group 70.6%,positive group 89.9%,post-eradication group 61.9%,and the overall difference was statistically significant(X2==11.678,P=0.003);The effect of lesion morphology on the endoscopic detection rate of H.pylori negative and H.pylori eradication was statistically significant.(negative:P=0.012;eradication:P=0.018),while the lesion size on the endoscopic detection rate of H.pylori positive patients was statistically significant(P=0.002).3.When the lesions under three different H.pylori infection states were observed under the microscope,the morphological manifestations of microglandular ducts and microvessels as well as the boundary lines of lesions were clearer with ME-NBI.Especially for the eradication of H.pylori,due to the characteristic alteration of the lesion surface,the use of ME-NBI is more advantageous.Conclusions 1.When the endoscopist finds gastr ic mucosal lesions during observation,if the patient is older,the lesion shape is concave,and the lesion size is larger than 1cm,the biopsy results of the lesion are more likely to be HGIN or EGC.2.Endoscopic physicians should determining the status o f H.pylori infection in patients when make endoscopic diagnosis,and have a certain understanding of the characteristics of lesions in various H.pylori infection states to reduce missed diagnosis.3.Regardless of the status of H.pylori infection,the accuracy of ME-NBI in the diagnosis of gastric cancer is significantly better than that of WLE.