Abstract
Background: Gastric adenoma is a direct precursor of gastric adenocarcinoma. However, natural history remains unclear and controversy persists around treatment of gastric adenoma, especially low grade dysplasia. Aim: By analysing the histological discrepancies between forcep biopsy and EMR specimen of the gastric adenoma and their clinicopathologic characteristics, we aimed to propose the indication for endoscopic resection of gastric adenoma. Methods: A total of 538 gastric adenomas (387 low grade dysplasia (LGD) and 151 high grade dysplasia (HGD) histologically proven on forcep biopsies) which were removed by EMR in Severance Hospital between Jan. 2004 and Dec. 2007 Non-neoplastic polyps, submucosal tumors, and gastric adenoma without preceding biopsies before EMR were excluded. Histologic gradings were based on Vienna classification. LGD on forcep biopsies were designated as group I, HGD on forcep biopsies as group II. Univariate and multivariate analyses of the clinical and endoscopic characteristics were performed to analyze factors affecting histologic discrepancies; lesion size, number of biopsy fragments, EMR methods, size of EMR specimen, and endoscopic findings such as surface type, presence of unevenness, fold change, erythema and ulcer. Results: Final diagnoses after EMR included 303 (56.3 %) LGD, 89 (16.5 %) HGD, 104 (19.3 %) differentiated adenocarcinoma, 8 (1.5 %) undifferentiated adenocarcinoma, and 34 nonneoplastic conditions. In group I, 87 (22.5 %) cases showed discordant histology after endoscopic resection; 48 (12.4 %) HGD, 31 (8.0 %) differentiated adenocarcinoma, and 4 (1.0%) undifferentiated adenocarcinoma. In group II, 110 (72.8 %) cases showed discordant findings after EMR; 37 (24.5%) LGD, 69 (45.7%) differentiated adenocarcinoma and 19 (12.6%) undifferentiated adenocarcinoma. In the univariate analysis of group I, lesion size, EMR methods, size of EMR specimen, erythema showed significant relationship with the histological discrepancy. (p=0.025, p=0.000, p= 0.001, and p=0.003, respectively). In the multivariate analysis, erythema was found to be statistically significant factor affecting histologic discrepancies. (p=0.034, OR=2.09, 95% CI=1.057-4.132) In the univariate analysis of group II, lesion size showed significant relationship with the histological discrepancy. (p=0.042) Conclusions: HGD on forcep biopsies needs to be endoscopically resected regardless of their endoscopic characteristics based upon our results. LGD on forcep biopsies with larger size, flat/depressed type, or erythema should be considered candidates for EMR.
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