| Objective1.In the course of the follow-up of patients with low grade intraepithelial neoplasia of gastric mucosa,the risk factors of pathological escalation after fine examination of low grade intraepithelial neoplasia of gastric mucosa by magnifying endoscopy combined with blue laser imaging and biopsy were discussed,and the progress and regression of low grade intraepithelial neoplasia of gastric mucosa and its follow-up interval were analyzed.2.According to vessel plus surface,to study the consistency between the endoscopic diagnosis of low grade intraepithelial neoplasia of gastric mucosa and the pathological diagnosis after fine examination and biopsy,and to evaluate the value of magnifying endoscopy combined with blue laser imaging in the diagnosis of precancerous lesions and early gastric cancer.Methods1.One hundred and forty-five patients who were diagnosed with low grade intraepithelial neoplasia of gastric mucosa,with or without glandular atrophy and intestinal metaplasia by white light endoscopy had fine examination and biopsy again through magnifying endoscopy combined with blue laser imaging.At the same time,whether the patient had been infected with Helicobacter pylori was detected.And the basic information of patients was required,such as age,gender and other information,to analyze the related factors of pathological upgrading of biopsy after fine examination with magnifying endoscopy combined with blue laser imaging.2.Totally 145 patients were included,all of whom underwent fine examination and biopsy by magnifying endoscopy combined with blue laser imaging.According to the vessel plus surface,the endoscopic gastric mucosal lesions were classified(cancerous and non-cancerous),and the correlation between the diagnosis of magnifying endoscopy combined with blue laser imaging and pathological diagnosis was analyzed according to the pathological gold standard of biopsy.Results1.The average age of 145 patients was 59.60±9.41(35-80 years old),including 88 males and 57 females.All patients were diagnosed as low grade intraepithelial neoplasia with or without atrophic gastritis or intestinal metaplasia by white light endoscopy,and 72 patients(49.66%)were over 60 years old.Univariate analysis showed that the risk factors for pathological escalation of biopsy after ME-BLI fine examination include age over 60 years old,Hp infection,atrophy and lesions over 2cm.However,gender and intestinal metaplasia have nothing to do with pathological escalation.The above-mentioned risk factors of pathological escalation were included in the multivariate Logistic regression equation,and the results showed that:the age over 60 years old was statistically significant for the intensive examination of pathological escalation(OR=4.42,95%CI1.39-14.00,P<0.01);The diameter of the lesion over 2cm was statistically significant for the intensive examination of pathological escalation(OR=8.48,95%CI2.59-27.80,P<0.01).The combination of HP infection was statistically significant for the intensive examination of pathological escalation(OR=17.81,95%CI5.19-61.16,P<0.01).Concomitant atrophy was statistically significant for the intensive examination of pathological upgrade(OR=7.43,95%CI2.17-25.47,P<0.01).2.Correlation between the diagnosis under magnifying endoscopy combined with blue laser imaging and pathological diagnosis:Using vessel plus surface,145 patients were diagnosed by ME-BLI,37 patients with cancerous lesions(HGIN,early cancer)and 108 patients with non-cancerous lesions;There were 40 cases of cancerous lesions(HGIN,early cancer)and 105 cases of non-cancerous lesions under biopsy and pathological diagnosis.The diagnosis under ME-BLI is consistent with the pathological diagnosis(Kappa value:0.947,P<0.001).The sensitivity,specificity,positive predictive value and negative predictive value of ME-BLI for predicting whether pathological escalation(early gastric cancer and HGIN)had occurred were 87.50%(35/40),98.10%(103/105),94.59%(35/37)and 95.37%(103/108),respectively.Conclusion1.Low grade intraepithelial neoplasia of gastric mucosa is a precancerous lesion,especially in patients with high-risk factors,such as age over 60 years,lesion diameter over 2cm,Helicobacter pylori(HP)infection,gastric mucosal atrophy and other factors;It is suggested that magnifying endoscopy combined with blue laser imaging should be used for intensive examination and follow-up.Compared with white light endoscopy,Magnifying endoscopy combined with blue laser imaging can make the scope of biopsy precise and improve the positive rate of lesion biopsy.2.The combination of magnifying endoscopy combined with blue laser imaging and vessel plus surface can accurately predict whether the lesions have pathological escalation.The endoscopic pathological follow-up of patients with low grade intraepithelial neoplasia of gastric mucosa through the application of magnifying endoscopy combined with blue laser imaging is helpful for early detection of gastric mucosal lesions,and adopting appropriate follow-up intervals and treatment methods according to the corresponding risk can reduce unnecessary waste of medical resources. |
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