| Objective:To analyze the clinicopathological features of patients with chronic gastritis and low grade intraepithelial neoplasia(LGIN)diagnosed by endoscopic biopsy,and to compare the clinicopathological data of patients with pathological upgrade after endoscopic submucosal dissection(ESD),and to explore the risk factors of pathological upgrade of LGIN after ESD.Methods:The clinical data of patients who were diagnosed as chronic gastritis with mucosal LGIN by endoscopic biopsy and underwent ESD in the First Affiliated Hospital of Dalian Medical University from February 2021 to November 2022 were collected.A total of 154 patients(164 lesions)were included in the study(experimental group),including 113 patients in the non-upgrade group(group A)and 41 patients in the upgrade group(group B).The 164 lesions were divided into 121 lesions in the pathological non-upgrade group(group A1)and 43 lesions in the pathological upgrade group(group B1).A total of 68 lesions were examined by magnifying endoscopy with narrow-band imaging(ME-NBI).There were 51 lesions in the non-upgraded group(group A2)and 17 lesions in the upgraded group(group B2).50 patients with chronic gastritis who matched the baseline clinical data of the experimental group at the same time were randomly selected as the control group.The basic data,clinical manifestations,laboratory examination,gastritis classification,helicobacter pylori(Hp)infection and intestinal metaplasia of the patients in the experimental group and the control group,the non-upgrade group and the upgrade group were retrospectively analyzed and compared.The characteristics of lesions under white light endoscopy and ME-NBI in the non-upgrade group and the upgrade group were further analyzed and compared,and the risk factors of gastric mucosal LGIN pathological upgrading were analyzed by univariate analysis and multivariate logistic regression analysis.Results:1.The average age of 154 patients was 63.0 years old,with 59.1% males,8.4%non-atrophic gastritis and 91.6% atrophic gastritis.There were no significant differences in gender,age,BMI,smoking history,drinking history,hypertension history,coronary heart disease history and diabetes history between the experimental group and the control group(P>0.05).A total of 41 patients with pathological upgrade after ESD had 43 lesions,among which 5 lesions had local canceration,all of which were intramucosal carcinoma.There were 113 patients with 121 lesions diagnosed as LGIN after ESD,and the diagnostic coincidence rate of gastroscopy biopsy was 73.8%(121/164).In 68 lesions examined by ME-NBI,the diagnostic coincidence rate of targeted biopsy was 75.0%(51/68),which was not significantly different from that of white light endoscopic biopsy(72.9%,70/96)(P>0.05).2.The proportion of males in group A was 60.2%,with an average age of 63.0years.The proportion of males in group B was 56.1%,with an average age of 64.0 years.There were no significant differences in gender,age,BMI,smoking history,drinking history,hypertension history,coronary heart disease history and diabetes history between group A and group B(P>0.05).3.In the experimental group and the control group,the clinical symptoms were common in abdominal pain,followed by acid reflux,heartburn,abdominal distension,abdominal discomfort,weight loss,there were no significant differences in clinical symptoms between the two groups(P>0.05).There were no significant differences in clinical symptoms between group A and group B(P>0.05).4.The mean values of tumor markers(alpha-fetoprotein,carcinoembryonic antigen,carbohydrate antigen 19-9),hemoglobin,albumin,and homocysteine(Hcy)in the experimental group and the control group were within the normal range,and the experimental group Hcy(10.6umol/L)was slightly higher than the control group(9.9umol/L),the differences were statistically significant(P<0.05).There were no significant differences in serological related indexes between group A and group B(P>0.05).5.Localized gastric wall thickening was observed on abdominal CT in 27.9%(43/154)of the experimental group.There were 26.5 % and 31.7% of patients with localized thickening of gastric wall in group A and group B,respectively.There were no significant differences between group A and group B(P>0.05).6.In the control group,the classification of atrophic gastritis was mainly C-1 and C-2,and the experimental group was mainly C-2 and C-3,and the differences between the two groups were statistically significant(P<0.05).The classification of atrophic gastritis in group A and group B was mainly C-2 and C-3,and there were no statistical differences between the two groups(P>0.05).The positive rates of Hp in the control group and the experimental group were 74.0% and 81.8%,respectively,and there were no statistical differences between the two groups(P>0.05).The positive rate of Hp in group A(77.9%)was lower than that in group B(92.7%),with statistical differences(P<0.05).7.Under white light endoscope,the lesions of gastric LGIN were mostly located in the antrum(58.5%),and the Paris types were mainly Ⅱa and Ⅱa+Ⅱc,while the central depression,erosion and spontaneous bleeding tendency were rare.There were no statistical differences in the above endoscopic performance between group A1 and B1(P > 0.05).The colors of the lesions were usually normal,and whiteness and redness were rare.There were statistically significant differences in the composition ratio of color changes between group A1 and group B1(P<0.05).The lesion diameter of group A1 was 1.0 cm(0.8,1.5),and that of group B1 was 1.5 cm(1.2,2.0).The differences between the two groups were statistically significant(P<0.05).8.ME-NBI microscopy showed clear boundary of the lesion(82.3%)and surface microstructure changes.Microglandular structure changes showed thickening,different shapes,disorders and local fusion;microvascular structure changes showed expansion,distortion,density and disorder.The proportions of microglandular disorder and microvascular distortion in group B2(70.6% and 64.7%)were higher than those in group A2(41.2% and 35.3%),and the differences were statistically significant(P<0.05).9.Univariate analysis showed that the proportion of red lesions,Hp infection positive,and lesion diameter>1.5cm in group B1 was higher than that in group A1(P<0.05),but there were no significant differences in males and age>60 years between the two groups(P>0.05).Multivariate logistic regression analysis showed that lesion diameter>1.5cm was an independent risk factor for pathological upgrading after gastric ESD in patients with LGIN diagnosed by gastroscopy biopsy(P<0.05).Conclusion:1.Chronic gastritis with mucosal LGIN is associated with lack of specific clinical manifestations and serological and imaging changes,and is more common in males over60 years of age.2.Positive Hp infection was associated with pathological upgrading in gastric LGIN patients after ESD surgery.3.Redness in the lesion and changes in the mucosal surface microstructure under ME-NBI,such as microglandular canal disturbance and microvascular distortion,suggest the possibility of pathological escalation.4.The lesion diameter>1.5cm is an independent risk factor for pathological upgrading after ESD in LGIN patients with gastric mucosa. |
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