Risk factors of pathological upgrading in gastric mucosa lesions with low-grade intraepithelial neoplasia after endoscopic submucosal dissection

Abstract

Objective To investigate the risk factors of pathological upgrading in gastric mucosal lesions with low-grade intraepithelial neoplasia (LGIN) after endoscopic submucosal dissection (ESD). Methods From January 2010 to December 2016, the complete clinical data of 326 patients pathologically diagnosed with gastric LGIN lesions before ESD were retrospectively analyzed. Single factor analysis of variance and multiple factor Logistic regression analysis were performed to analyze the risk factors of pathological upgrading after ESD. Results A total of 326 patients with gastric LGIN lesions diagnosed by preoperative biopsy before ESD were enrolled. Among them the postoperative pathological diagnosis of 244 cases (74.85%) were still LGIN, while the postoperative pathological diagnosis of 82 cases (25.15%) were upgraded, of which 61 cases (18.71%) were upgraded to high-grade intraepithelial neoplasia and 21 (6.44%) were upgraded to gastric early cancer. The results of single and multiple factor analysis indicated that lesion size≥2.0 cm, deep depressed-type, surface erythema, lesion mucosa with ulceration and lesions with spontaneous bleeding were the risk factors of pathological diagnosis upgrading after ESD (F=5.37, 6.44, 4.56, 7.56 and 7.78, respectively; all P<0.01), odds ratio (OR) value and 95% confidence interval (CI) were 4.086 (2.035 to 10.786), 7.435 (2.845 to 19.862), 3.205 (1.535 to 8.541), 8.668 (3.365 to 21.457) and 7.056 (2.732 to 18.355). The age, gender and location of the lesion were not the risk factors. Conclusions Pathological upgrading is common in gastric lesions with LGIN after ESD. The lesions with high risk factors should be alerted and treated more actively. Key words: Gastric low-grade intraepithelial neoplasia; Endoscopic submucosal dissection; Pathological upgrading; Risk factors