Risk Factors Of Endoscopic Submucosal Dissection For Non-curative Resection Of Early Gastric Cancer And Diagnostic Value Of Endoscopic Ultrasonography In The Invasive Depth Of Early Gastric Cancer

Background: Early gastric cancer(EGC)is characterized by tumor infiltration confined to the mucosa or submucosa,regardless of the lesion size and lymph node metastasis.Endoscopic submucosal dissection(ESD)has gradually become the preferred operation of EGC,however,some patients will have non-curative resection and require additional surgery.At present,there is no consensus in China on the risk factors for ESD non-curative resection of EGC.Furthermore,preoperative evaluation of invasive depth is of great value in guiding the selection of treatment,endoscopic ultrasonography(EUS)can identify five layer structures of the stomach,and it is an important way to evaluate gastrointestinal tumor stage,however,there are different reports on the diagnostic value of EUS in the invasive depth of EGC at different countries.Objective: To investigate the risk factors of non-curative resection of EGC after ESD;and the diagnostic value of EUS in the invasive depth of EGC.Methods:(1)Risk factors of endoscopic submucosal dissection for non-curative resection of early gastric cancer: Between December 2010 and December 2018,clinical,endoscopic and pathological data of patients with EGC(including high-grade intraepithelial neoplasia(HGIN))who underwent ESD at the digestive endoscopy center of the first affiliated hospital of Nanchang university were retrospectively collected.univariate and multivariate analysis methods were used to analyze the risk factors associated with ESD non-curative resection.(2)Diagnostic value of endoscopic ultrasonography in the invasive depth of early gastric cancer:The clinical,endoscopic and pathological data of patients with EGC(including HGIN)who were admitted to the first affiliated hospital of Nanchang university digestive endoscopy center and performed ESD between December 2010 and December 2018 were retrospectively analyzed,the preoperative EUS were performed,and the pathological invasive depth as the diagnostic gold standard,the results of EUS were compared with pathology findings for invasive depth.Paired chi-square test was used to analyze the diagnostic value of EUS,and univariate andmultivariate analysis methods were used to analyze the risk factors affecting the diagnostic accuracy.Results:(1)Risk factors of endoscopic submucosal dissection for non-curative resection of early gastric cancer: A total of 191 EGC were included.The en bloc resection rate was 98.4%(188/191),the complete resection rate was 85.3%(163/191),and the curative resection rate was 75.4%(144/191).Logistic regression analysis found that tumor diameter>20mm(OR=10.187,95%CI:3.427~30.283),ulceration(OR=3.850,95%CI:1.541~9.616),undifferentiated tumor histology(OR=11.915,95%CI:3.395~41.817)and submucosa invasion(OR=8.197,95%CI : 2.186 ~ 30.737)were independent risk factors for ESD non-curative resection of EGC,with the increase of risk factors,the rate of non-curative resection also increases.(2)Diagnostic value of endoscopic ultrasonography in the invasive depth of early gastric cancer: The overall accuracy of EUS in terms of invasive depth was 74.1%,and the sensitivity,specificity,positive predictive value and negative predictive value to diagnosis of mucosal lesions were 74.8%,66.7%,95.9% and20.4%,respectively.Multivariate analysis revealed that mucosal depression was an independent risk factor affecting the accuracy of EUS.Conclusion:(1)ESD treatment should be more cautious for EGC patients with tumor diameter>20mm,ulceration,undifferentiated tumor histology and submucosa invasion,for the risk of non-curative resection after ESD is significantly increased.(2)EUS can be used as a test method to assess the invasive depth of EGC.For lesions with mucosal depression,the diagnostic accuracy may be reduced.