Diagnostic And Curative Effect Of Endoscopic Resection For Gastric High-grade Intraepithelial Neoplasia

Objective:To investigate the risk factors for upgraded pathology and non-curative resection of gastric high-grade intraepithelial neoplasia(HGIN)using endoscopic submucosal dissection(ESD).Methods:We retrospectively reviewed the information from 123,460 patients who underwent gastroscopy at the First Affiliated Hospital of Nanjing Medical University,from January 2010 to December 2015.Among them,1,212 patients were initially diagnosed as HGIN according to endoscopic forceps biopsy(EFB),endoscopic ultrasonography(EUS)and computed tomography(CT).Subsequently,134 patients who were treated with ESD were enrolled in our study.The clinical manifestation,endoscopic appearance including lesion location,size,erythema,erosion,number of biopsy and histopathological information such as infiltrating depth,macroscopic pattern and surgical margin were collected.The pathological diagnoses before and after ESD were compared and the risk factors for the upgrade were analyzed.Furthermore the risk factors for non-curative resection after ESD were also analyzed.Results:Among the enrolled 134 patients,99(73.88%)patients had their pathologies confirmed of HGIN and 35(26.12%)patients had their pathologies upgraded to early gastric cancer(EGC)after ESD.Compared to the concordant group,the lesion size?2 cm,number of biopsy ?4 and symptom of upper gastrointestinal bleeding(UGIB)were significantly more frequent in the upgraded group(P<0.05).Further multivariate regression analysis demonstrated that the lesion size?2cm(OR=5.162,95%Cl:2.042-13.048,P<0.01),biopsy number ?4(OR=2.731,95%CI:1.150-6.484,P<0.05)presence of UGIB(O=15.636,95%CI:1.289-189.749,P<0.05)were independent risk factors for upgraded pathology.The whole sample group of 134 patients underwent en bloc resection,however,only 106 patients(79.10%)had a curative resection.Further investigations revealed that patients with the following criteria are more likely to have a positive margin after ESD:male,age>65 years,a lesion size?2cm and up-graded pathological diagnosis(P<0.05).Additional multivariate regression analysis demonstrated that up-graded pathological diagnosis(OR= 3.561,95%Cl:1.364-9.300,P<0.05)was independent risk factor for non-curative resection.Conclusions:For suspected gastric HGIN patients,risk factors like lesion size,number of biopsy and signs of UGIB should be taken into account before preparing ESD.