| Part one Objective: To investigate the effect of intravenous anesthesia on the detection rate of pathological changes in diagnostic gastroscopy.Methods:A total of 9071 individuals who underwent gastroscopy at the Gastrointestinal Endoscopy Center of the Affiliated Hospital of Yangzhou University between 01.03.2021 and 28.02.2022 were registered.The age,sex,examining physician,Helicobacter pylori(H.pylori)infection,examination method,exit time,number of images,number of biopsies,biopsy site,gastroscopy diagnosis and pathological diagnosis of the subjects were collected from the gastroscopy quality control system.According to the examination method,the subjects were divided into anesthesia group and normal group.Propensity Score Matching(PSM)was performed for the two groups of subjects,and confounding factors were excluded,and the detection of lesion location and lesion type was analyzed.At the same time,the factors influencing the detection rate of precancerous lesions and malignant tumors of upper digestive tract were investigated.Results:After PSM,1655 subjects were enrolled in each group.In terms of lesion site,the detection rate of lesion in gastric body in anesthesia group was higher than that in normal group.In terms of lesion types,the detection rate of gastric polyp,mucosal eminence,mucosal atrophy,intestinal metaplasia and other precancerous lesions in anesthesia group was higher than that in normal group(P < 0.05).Logistic regression model was then established for the post-PSM cohort,and it was found that intravenous anesthesia was an independent factor influencing the detection rate of precancerous lesions and malignant tumors in diagnostic gastroscopy(OR=1.338,95%CI:1.070-1.674,P<0.05).Conclusion:Intravenous anesthesia is an independent factor that affects the detection rate of precancerous and malignant lesions during diagnostic gastroscopy and may improve the detection rate of lesions in the upper gastrointestinal tract.The study provides evidence to support the use of anesthetic sedation as an essential indicator of gastroscopy quality and has important clinical implications.Part two Objective: In the present study,we aim to create an early predictive model of precancerous conditions of the stomach based on laboratory testing in healthy populations,thus timely identifying high-risk people of GC.Methods: A total of 993 subjects receiving gastroscopy at the Health Management Centre of the Affiliated Hospital of Yangzhou University from January 2018 to June 2021 were retrospectively recruited.Univariate and multivariate logistic regression analyses were performed to identify risk factors for precancerous conditions of the stomach,followed by creating a predictive nomogram based on the multivariate logistic regression model.The receiver operating characteristic(ROC)curve,calibration curve and decision curve to determine the nomogram’s diagnostic potential,accuracy and clinical utility.Results: Age,smoking,hypertension,Helicobacter pylori(H.pylori)infection,history of gastric ulcer,albumin(Alb)level,serum creatinine(Scr)level and hemoglobin(Hb)level were independent risk factors for precancerous conditions of the stomach.A nomogram was then created based on the results of the multivariate logistic regression analysis to calculate the risk of precancerous conditions of the stomach for an individual.The area under the curve(AUC)was 0.680.The prediction curve was well fitted with the ideal curve.The decision curve analysis(DCA)plotted the net benefit against threshold probability ranging 0.2-0.9.Conclusion: We created a risk prediction model for precancerous conditions of the stomach based on routine laboratory testing in healthy populations and validated its clinical significance.Age,smoking,hypertension,H.pylori infection,history of gastric ulcer,Alb,Scr and Hb levels were risk factors for precancerous conditions of the stomach.The established nomogram contributed to early identification of high-risk people of GC. |
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