| Objective:1.To summarize the clinical characteristics and pathological types of ESD patients with gastric mucosal lesions in five hospitals in Northern Shaanxi,and analyze the related factors of EGC;2.To summarize the differences of pathological diagnosis after endoscopic biopsy and ESD in patients with gastric mucosal diseases,and analyze the related factors of pathological upgrading,so as to provide some guidance for early cancer screening and intervention treatment.Methods : The patients who underwent ESD treatment for gastric mucosal lesions in the Affiliated Hospital of Yan’an University,Yan’an people’s Hospital,Yulin first people’s Hospital,Yan’an Hospital of traditional Chinese medicine and Zichang people’s Hospital from January 1,2016 to December 30,2021 were collected.According to the inclusion and exclusion criteria,the general data of the patients（gender,age,smoking history,drinking history,family history,HP infection）were collected endoscopic data（endoscopic lesion location,size,shape,redness,nodule,ulcer,number of preoperative biopsy samples）,preoperative and postoperative pathological data（including whether the cutting edge remains and the depth of lesion infiltration）and the occurrence of complications（bleeding and perforation）.Statistically analyze the above data,analyze the clinical characteristics of patients,summarize the related factors of EGC,compare the consistency of preoperative EFB and postoperative pathological diagnosis of ESD,analyze the relevant factors of postoperative pathological upgrading,and summarize the incidence of ESD complications.Results:1.total of 230 cases were included in this study,including 140 males and 90 females,with a male to female ratio of 1.56:1,and 130 cases（53.9%）were older than60 years,with a mean age of 61 years.No family history of gastric cancer was present in any of the patients.Of the patients included in this study,219（95.2%）had a single lesion,11（4.8%）had two lesions,and a total of 241 lesions were resected.Of the 241 lesions,31 lesions were located in the cardia,5 in the fundus,54 in the body,28 in the angle,and 123 in the antrum.The overall cases were mainly of the bulge type,the second was the flat type,the lesion size was more than ≤ 2 cm,the surface redness and surface ulceration were more common.2.According to the postoperative pathological condition,the patients undergoing ESD were divided into CIC group,LGIN group,HGIN group and EGC group,and compared with each other,it was found that there were significant differences in lesion size,endoscopic classification,surface redness and surface ulcer among the four groups（P < 0.05）.After further pairwise comparison,it was found that there were significant differences in lesion location and endoscopic classification between CIC group and LGIN group.There were significant differences in lesion location,endoscopic classification and surface ulcer between CIC group and HGIN group,lesion size,endoscopic classification,surface redness and surface ulcer between CIC group and EGC group,and surface ulcer between LGIN group and HGIN group.3.The overall concordance rate between preoperative EFB diagnosis and postoperative pathological diagnosis was 53.94%（130 / 241）,and the upgrade rate was 31.54%.4.The patients were divided into ascending and non ascending groups according to the preoperative pathological difference of ESD,and the factors associated with pathological upgrade in CIC,LGIN,and HGIN groups were analyzed separately.Endoscopic subtyping（OR: 0.134,CI: 0.029-0.617）and superficial ulceration（0R,3.596,CI: 1.226-10.536）were associated with pathological upgrade in the CIC group;In the LGIN group,increasing pathologic grade was associated with younger age（OR: 3.961,CI: 1.071-14.650）,endoscopic classification（OR: 0.331,CI:0.127-0.765）,superficial redness（OR: 5.830,CI: 1.591-21.355）,and number of withdrawals（OR: 234,CI: 0.063-0.872）were related;Large lesion size（or: 3.143,CI:1.003-9.852）was associated with pathological upstaging of HGIN.5.For 241 lesions treated with ESD in this study,the en bloc resection rate was99.58%,the complete and curative resection rates were 91.70%,the intraoperative bleeding rate was 1.24%,and the intraoperative perforation rate was 1.24%.Conclusion:1.If the lesion appears endoscopically flat,> 2 cm in diameter with surface redness and ulceration,it should alert to the possibility of EGC.2.The pathological upgrading rate after ESD for gastric mucosal lesions in Northern Shaanxi was 31.54%,which was basically consistent with the results reported at home and abroad.3.If the preoperative biopsy is suggestive of CIC,but the lesions are endoscopically classified as flat or concave with surface ulceration,they should be alert to the possibility that the pathology is underestimated;The preoperative biopsy was suggestive of LGIN,but when the patient was aged > 60 years,the lesion was flat type,the surface of the lesion was red and only 1 block was taken for biopsy,it was not excluded that the preoperative pathology was underestimated and ESD was feasible if necessary;With lesion size > 2cm,the lesion diagnosed as HGIN by preoperative biopsy was likely EGC,and ESD was recommended. |
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