Analysis Of Endoscopic Submucosal Dissection In The Treatment Of 255 Patients With Early Gastric Cancer And Precancerous Lesions

Purposes:1.Analyze the clinical characteristics of early gastric cancer..2.Investigate the morphological characteristics and ME-NBI features of early gastric cancer lesions under white-light gastroscopy,and to provide reasonable suggestions for endoscopic screening.3.Investigate the consistency of endoscopic biopsy and endoscopic submucosal dissection(ESD)in the diagnosis of early gastric cancer and precancerous lesions.4.Summarize the en bloc resection rate,complete resection rate,tissue healing resection rate,complications(bleeding,perforation)and recurrence of ESD in the treatment of early gastric cancer and precancerous lesions,and to evaluate the surgical effect of ESD in the treatment of early gastric cancer and precancerous lesions.Methods:A retrospective analysis of the clinical,endoscopic,pathological and ESD data of patients with early gastric cancer and precancerous lesions diagnosed by endoscopy and/or biopsy in the Affiliated Hospital of Qingdao University,Shinan District,from January 2016 to December 2017.According to the pathological results from ESD specimens,the patients were divided into: low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN)and early gastric cancer(EGC)group.It was conducted to analyze the clinical manifestations of early gastric cancer,endoscopic and pathological features of early gastric cancer and precancerous lesions,and the therapeutic effect of ESD.Results:(1)There were 173 males and 82 females in 255 patients undergone ESD treatment.The ratio of males to females was about 2:1.There were 23 cases(9.0%)with family history of gastric cancer.The detection rate of HP infection was 35.6%(90/253).The main symptoms of early gastric cancer patients were abdominal pain,abdominaldistension,upper abdominal discomfort,without specificity.(2)There were 255 patients undergone ESD teatment,230(90.2%)patients had one lesion,while 25(8.8%)patients had multiple lesions,and 280 lesions were resected.According to the pathological results after ESD,20 lesions were inflammation and glandular hyperplasia,157 LGIN,42 HGIN and 61 EGC.The majority of early gastric cancer lesions were type II C under white light endoscopy,accounting for 49.2%(30/61).The main features of early gastric cancer under ME-NBI are demarcation line between lesion and surrounding mucosa,irregular surface micro-structure and microvessel.Among 61 early gastric cancer lesions,58 lesions were intramucosal carcinoma,and 3lesions were infiltrated into submucosa.12 lesions were poorly differentiated adenocarcinoma,5 lesions were poorly-moderately differentiated adenocarcinoma,14 lesions were moderately differentiated adenocarcinoma,2 lesions were moderately-well differentiated adenocarcinoma and 21 lesions were well-differentiated adenocarcinoma.There were 7 early gastric cancer lesions with unknown differentiation.According to the pathology after ESD,the patients were divided into GIN group and EGC group(HGIN belonged to GIN group).Single factor chi-square test showed that there were significant differences in HP infection(P=0.033),gastric mucosal atrophy(P=0.007),sex(P=0.042),lesion size(>2.0cm)(P=0.010),and endoscopic ulcer depression(P=0.047).Multivariate logistic regression showed that HP infection(P=0.028),atrophy of gastric mucosa(P=0.029)and lesion size(>2.0cm)(P=0.022)were risk factors for early gastric cancer.(3)The overall coincidence rate of gastroscopic biopsy and ESD pathology in the diagnosis of early gastric cancer and precancerous lesions was 71.8%(198/266),and the overall variation rate was 21.2%(75/266).The coincidence rates of gastroscopic biopsy and ESD pathology in LGIN,HGIN and EGC were 80.4%(131/163),38.1%(24/63)and90.0%(36/40),respectively.(4)The en bloc rate of ESD was 100%,the complete resection rate was 96.4%,and the histological cure resection rate was 96.4%.One patient had perforation during operation,one patient had delayed perforation after operation,one patient had bleeding after operation,one patient had pyloric stenosis after operation,and one patient had ulcer after ESD and turned to general surgery.After ESD,3 patients had residual lesions,3patients had local recurrence and 4 patients had simultaneous recurrence.Conclusions:(1)There were no characteristic symptoms and signs in patients with early gastriccancer.(2)Mainly morphological characteristics of early gastric cancer lesions under white light endoscopy were type II c,while the main features of early gastric cancer under ME-NBI are the boundary between lesion and surrounding normal mucosa,irregular surface micro-structure and microvessel.(3)Gastroscopy biopsy and pathology after ESD are partially in the diagnosis of early gastric cancer and precancerous lesions.(4)ESD in the treatment for early gastric cancer and precancerous lesions has high complete resection rate,high tissue cure resection rate and low recurrence rate.