| Objective:To investigate the endoscopic pathological detection of gastric intraepithelial neoplasia(GIN)in the Gastrointestinal Endoscopy Center of the Affiliated Hospital of Yan’an University,and analyze its clinical features and relevant factors affecting the pathological prognosis of gastric low-grade intraepithelial neoplasia(LGIN),so as to provide a reliable basis for early monitoring and treatment,and thus improve the diagnosis and treatment rate of early gastric cancer.Methods:From January 2016 to December 2022,the clinicopathological data of all patients who were first confirmed as GIN by gastroscopy and endoscopic forceps biopsy(EFB)at the Gastrointestinal Endoscopy Center of our hospital were collected.A total of1206 patients were included in a case-control study to explore the detection of GIN,LGIN and HGIN,and to analyze the clinical characteristics of GIN in different age groups(low-aged group,middle-aged group,elderly group)and low-grade and high-grade intraepithelial neoplasia group,as well as the situation of GIN combined with atrophy and intestinal metaplasia.Patients with pathologically confirmed LGIN after September 2019 were followed up for 2 years.A total of 86 patients who met the follow-up requirements were included and divided into regression group(56 cases)and non-regression group(30 cases)according to their first and last pathological results.Univariate and multivariate analyses were performed to screen for relevant factors affecting their prognosis.Results:1.The total endoscopic detection rate of GIN was 1.44%,while LGIN and HGIN were1.28%and 0.16%,respectively.The detection rate of GIN decreased with the years.The change trend of LGIN’s detection rate with year was the same as that of GIN,while the change of HGIN was little.2.Among the 1206 GIN patients in this study,810 were males and 396 were females,with a male-to-female ratio of 2.05:1.The average age was(56.17±11.01)years old,and 72.0%(868/1206)of the patients were 50 years old and above.The mean age of LGIN patients was(55.31±10.79)years old,and that of HGIN patients was(63.07±10.26)years old.There was significant difference in the age of first onset between the two groups(P<0.05).The most common sites for GIN,LGIN,and HGIN were the gastric antrum,which were 53.4%(644/1206),55.4%(593/1071),and 37.8%(51/135),respectively.The proportion of gastric body and cardiac fundus in HGIN was higher than that in LGIN(45.2%vs 22.4%).Among the three groups,there were significant differences in gender,lesion site and Hp infection(P<0.05).Inter group comparison results ofχ~2 test showed that there were significant differences in gender and Hp infection between the middle-aged group and the elderly group(both P<0.017),but there was no significant difference in the other groups(P>0.017).The most common lesion location in GIN patients of all age groups was the gastric antrum,and the distribution of gastric antrum,gastric body,and cardiac fundus in each age group had significant differences(P<0.05).While the gastric angle had no significant differences(P>0.05).3.The occurrence of intestinal metaplasia in patients with GIN was related to age,lesion location and Hp infection(P<0.05),while atrophy was related to age,location,microscopic morphology and Hp infection(P<0.05).4.By comparing the clinical characteristics of patients with LGIN and HGIN,it was found that there were significant differences in age of onset,lesion site,microscopic morphology,lesion size,redness of mucosa,surface nodules,surface ulcers,atrophy and Hp infection between the two groups,but there was no significant difference in gender and number of lesions(P>0.05).5.A total of 86 patients with LGIN were followed up,with a male to female ratio of4.06:1 and an average age of(59.23±8.70)years.Analysis of relevant factors affecting the outcome of LGIN revealed that the location of the lesion at the cardia and fundus of the stomach(OR=7.756,95%CI:1.260～47.734)and the size of the lesion(OR=6.852,95%CI:1.917～24.491)were independent related factors for the persistence or progression of LGIN(P<0.05).Conclusion:1.The total detection rate of gastric GIN was 1.44%,which was basically consistent with the results reported by relevant domestic researchers.2.The middle-aged and elderly patients accounted for the majority of GIN,and the gastric antrum was the most common site of onset.The proportion of patients with HGIN who were older,lesions size greater than 10mm,lesions in the proximal stomach,positive Hp infection,and mucosal redness,nodules,ulcers and atrophy was higher than that with LGIN.The rate of intestinal metaplasia and atrophy was higher in the elderly and Hp infection with GIN patients.3.The lesion located in cardia and fundus of the stomach and size larger than 10mm were independent relevant factors affecting the prognosis of LGIN.For LGIN patients whose lesions are located in cardia and gastric fundus or/and lesions size larger than10mm,it is recommended to perform endoscopic submucosal dissection(ESD)to further clarify the diagnosis and treatment based on comprehensive consideration of the risk of canceration and various burdens brought by close follow-up. |
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