| Background: Gastric cancer is one of the most common malignancies of the digestive tract,the fifth most common malignancy and the third leading cause of cancer-related death.Usually,when diagnosed,it is already in the middle and advanced stages,and the five-year survival rate is very low.In 2018,about 784,000 [1] patients died of gastric cancer in the world,bringing a serious economic burden to the world.The development of gastric cancer is a long and complex process involving multiple factors and steps.Gastric mucosal low-grade intraepithelial neoplasia(LGIN)is an important step in the development of gastric cancer.Rational clinical management of LGIN can greatly reduce the incidence and mortality of gastric cancer.However,different clinical guidelines provide different treatment principles for gastric mucosal LGIN,and there is currently no universally accepted standard for the evaluation and management of gastric mucosal LGIN in the world.Objective: Endoscopic biopsy is the most important diagnostic tool for gastric low-grade intraepithelial neoplasia(LGIN).However,the final pathological diagnosis after endoscopic resection may be different from the biopsy results.For gastric LGIN,there are currently no generally accepted guidelines for which lesions should be resected and which lesions should be monitored with follow-up.The purpose of this study is to study the pathological results of gastric LGIN confirmed by biopsy after endoscopic resection and the risk factors for pathological upgrading,so as to guide the clinical use of reasonable treatment for gastric LGIN.Two kinds of endoscopic resection(EMR,ESD)were compared.Methods: From June 2015 to June 2020,74 cases of gastric mucosal LGIN diagnosed by biopsy were included in the pathological database of Shiyan People’s Hospital,so all patients underwent endoscopic resection.The clinical data were analyzed retrospectively.To investigate the endoscopic risk factors associated with postoperative pathological upgrading of high-grade intraepithelial neoplasia(HGIN)or gastric cancer.The therapeutic effect and complications such as bleeding and perforation were compared between the two endoscopic resection methodsResults: The mean age of enrolled patients was 54.93±10.43 years,and 56.8%were males.The predominant location was gastric antrum,accounting for 64.9%.The most common gross type of lesions was the elevated type(60.8%).The rates of pathological concordance,upstage,and downstage diagnosis were 81.1%,16.2% and2.7%,respectively.Univariate analysis showed that lesion diameter ≥1cm,surface erythema and erosion were the risk factors for pathological upgrading after endoscopic resection.Multivariate regression analysis showed that lesion diameter ≥1cm(OR 18.2;P=0.027)was a risk factor for pathological progression.Forty patients underwent EMR and 34 underwent ESD.The en block resection rate(94.1%)and complete resection rate(82.4%)in ESD group were significantly higher than those in EMR group(65.0%,60.0%),and the difference was statistically significant.There was no significant difference in the risk of bleeding and perforation between the two groups.Conclusions: The study found that some gastric mucosal LGIN diagnosed by endoscopic biopsy had pathological upgrading after endoscopic resection,and the lesion diameter ≥1cm was a risk factor for postoperative pathological upgrading.For such patients,more careful and meticulous biopsy should be conducted,and endoscopic resection should be required to further clarify the diagnosis if necessary.There was no statistically significant difference in the risk of bleeding and perforation complications between the two endoscopic resection methods,but ESD had higher en block resection rate and complete resection rate.If the lesion is large and cannot be completely removed by EMR at one time,ESD can be used. |
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