| Objective To analyze the clinical and endoscopic characteristics of low-grade gastric intraepithelial neoplasia,and evaluate the potential predictive factors for carcinomatous transformation of LGIN.Methods This study involved 374 LGIN or low/medium-grade dysplasia that were histologically Initial confirmed by endoscopic forceps biopsy(EFB)at the first People’s Hospital of Yi Chang between January 2012 and December 2018.then,we evaluated the clinical and endoscopic characteristics,and pathological features.We set up a exclusion criteria were as follows: a history of endoscopic submucosal dissection(ESD)or endoscopic mucosal resection(EMR)after confirmed to LGIN,residual stomach,gastric adenoma,incomplete data,and refusal to follow up.Finally,130 patients with LGIN were selected to be followed up to study the outcome and the relationship between gastric cancer and its related factors,all patients were Collected with clinical data and endoscopic features,such as age,gender,location in stomach,The lesion of the size(largest diameter),type(prominent,flat,or depressed),color change(red,white,or no change),appearance(ulceration,erosion,nodule,erythema),family gastric cancer history(FCH);history of smoking and alcohol abuse,the dietary habit of pickled products,and infection with Helicobacter pylori(Hp),intestinal metaplasia(IM)and gastric atrophy(GA),According to EFB pathological findings about the whether it disappears,they were divided into deterioration group and no deterioration group,take univariate and multivariate analyses explored the risk factors of LGIN.Results 1)The total endoscopic detection rate of GIN was 0.91%,it was continusly increased from 2012 to 2018.Of the 374 LGIN,the ratio of male to female was1.75:1,The mean age was(58.96 ± 10.90)years,Among them,the highest proportion of the 50 to 65 years,The most common clinical symptoms were abdominal pain,abdominal distension,and upper abdominal discomfort,LGIN was mostly located in gastric antrum(63.9%),location and endoscopic presentations were different in age(P﹤0.05),the size of the lesions was 0.5-1.9cm(81%),The lesions were mostly prominent,the rate was64.7%,and the nodules(29.7%)and erosions(30.2%)had a higher positive rate in the lesion of LGIN;the gastric cardiac and fundus had a higher positive rate of IM and GA in the lesion of LGIN(P﹤0.05),and no significant differences were observed in the degree of GA and IM at the location in stomach(P﹥0.05),LGIN associated with Hp infection was most frequently detected in male(P﹤0.05).2)For follow-up,the ratio of male to female was 1.7:1,The mean age was(56.83±10.47)years,The total malignant transformation rate of LGIN in 130 patients was 11.5%,To identify potential risk factors for LGIN,Single factors analysis were conducted,and it was found that the location in stomach,the size,the type,the appearance,family gastric cancer history,history of alcohol abuse,LGIN associated with gastric atrophy,with the lesion progress were risk factors for LGIN(P﹤0.05),while color change,Hp infection,intestinal metaplasia,he dietary habit of pickled products had no influential effect(P﹥0.05),univariate logistic regression analysis showed that lesions occurred in gastric corpus(P=0.004,OR=4.9,95%CI:2.026-6.438),lesions more than 2.0 cm in diameter(P=0.023,OR=5.4,95%CI:3.256-8.943),ulcer lesions(P=0.006,OR=3.5,95%CI:1.305-5.706),depression lesion(P=0.023,OR=4.4,95%CI:1.356-6.410),gastric atrophy(P=0.036,OR=1.3,95%CI:1.013-2.805),family gastric cancer history(P=0.001,OR=21.4,95%CI:5.062-25.391),history of alcohol abuse(P=0.03,OR=3.2,95%CI:2.012-5.826)were independent risk factors for the progression of LGIN.Conclusion 1)LGIN is a precancerous lesion in gastric carcinogenesis,the clinical syptom is nonspecific,it most commonly in the antrum,the size of lesions the was0.2-0.5cm,The lesions were mostly prominent,and the nodules and erosions had a higher positive rate in the lesion of LGIN;2)The location in stomach,the size,the type,the appearance,family gastric cancer history,history of alcohol abuse,LGIN associated with gastric atrophy,with the lesion progress were risk factors for LGIN,in which lesions occurred in gastric corpus,lesions more than 2.0 cm in diameter,ulcer lesions,depression lesion,gastric atrophy,family gastric cancer history,history of alcohol were more risk than the lesions occurred in gastric antrum,the lesions was 1.0-1.9cm,flat lesions,erosion lesions,nonassociated gastric atrophy,no family gastric cancer history,no history of alcohol were independent risk factors for the progression of LGIN.When the LGIN with these clinical and endoscopic characteristics,should be considered for EMR/ESD. |
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