Analysis Of Risk Factors Of Pathological Escalation After Endoscopic Submucosal Dissection Of Gastric Intraepithelial Neoplasia

Objective: To compare the pathological results of preoperative endoscopic biopsy and endoscopic submucosal dissection in patients with gastric intraepithelial neoplasia,and to analyze the causes of the differences in preoperative and postoperative pathological results.To explore the risk factors of postoperative pathological upgrading and the methods of improving the accuracy of endoscopic biopsy in order to guide the best clinical treatment of gastric intraepithelial neoplasia.Methods: A retrospective study was conducted to collect the clinical data of 215 patients with gastric intraepithelial neoplasia confirmed by endoscopic biopsy in another hospital or our hospital from January 2016 to July 2019.The patients’ sex,age,lesion location,lesion size,endoscopic lesion classification,surface redness,surface nodules and surface ulcers were recorded.Among them,59 cases were examined by magnifying endoscopy combined with narrow band imaging before operation,and the changes of the lesion boundary,microvessels and microglands observed by ME-NBI were recorded.The results of preoperative and postoperative pathological diagnosis were compared,the clinical and endoscopic features of the patients and the causes of differences in preoperative and postoperative pathological results were analyzed,and the risk factors of postoperative pathological escalation were discussed.Results: The clinical data of 215 cases were collected,including 151 males and 64 females.There were 137 patients over 60 years old and 78 patients younger than 60 years old.There were 59 patients examined by magnifying endoscopy combined with narrow band imaging before operation.The overall coincidence rate of preoperative EFB and postoperative pathology after ESD was 41.9%(90/215),the postoperativepathological upgrading rate was 40.9%(88/215),and the degradation rate was 17.2%(37/215).There were 107 cases of low-grade intraepithelial neoplasia diagnosed by preoperative biopsy,and the coincidence rate of postoperative pathological diagnosis was 60.7%(65/107).After operation,15.9%(17/107)of cases were upgraded to high-grade intraepithelial neoplasia,and 15.0%(16/107)of cases were upgraded to early gastric cancer.The overall upgraded rate was 30.9%(33/107),and 8.4%(9/107)of cases were downgraded to chronic inflammation.The preoperative EFB pathology showed HGIN in 108 cases,and the coincidence rate of the postoperative pathological diagnosis was 23.2%(25/108).The postoperative pathological upgrade to EGC was50.9%(55/108),and the postoperative demotion to LGIN and chronic inflammation were 23.1%(25/108)and 2.8%(3/108),respectively.The overall degradation rate was25.9%(28/108).The results of univariate analysis showed that age,lesion location,lesion size,surface nodules,surface redness,irregularity or disappearance of microglands were related to pathological upgrading(P < 0.05).The results of multivariate logistic regression analysis indicated that lesions > 2cm,nodules and redness on the surface of the lesions were independent risk factors for postoperative pathological escalation(P < 0.05).Conclusion: The age of the patient,the location of the lesion,the lesion size,the surface nodule,the surface redness,and the irregular or disappearance of MS are related to the pathological upgrade after ESD.The lesions > 2cm,nodules and redness on the surface of the lesions were the independent risk factors for pathological escalation after ESD.