Long-term Effects And Relative Factors Analysis On Recurrence Of Endoscopic Submucosal Dissection Upon High-grade Gastric Intraepithelial Neoplasia And Early Gastric Cancer

Objective:To evaluate on the long-term effects of endoscopic submucosal dissection(ESD)upon high-grade gastric intraepithelial neoplasia(HGIN)and early gastric cancer(EGC),and analyze the postoperative recurrence related risk factors.Methods:Review the 444 patients who were treated by ESD and then diagnosed with HGIN and EGC as a result of postoperative pathological diagnosis both conducted at the Digestive Endoscopy Center of Chinese PLA General Hospital from November 2006 to January 2016,visit and investigate their living condition subsequently,and summarize,analyze and evaluate the ESD curative effects in conjunction with the clinical pathology,including en bloc resection rate,complete resection rate,curative resection rate,survival rate,complications and recurrence rate;and conduct a statistical analysis of the recurrence related factors,including age,gender,diseased region,endoscopic classification,lesion size,histological classification,depth of invasion,whether or not en bloc resection.Results:Among the 444 patients treated by ESD,a total of 451 lesions were resected,including 216 intramucosal carcinoma(47.9%),45submucosal cancer(10.0%)and 190high-grade intraepithelial neoplasia(42.1%).The one-time en bloc resection rate,complete resection rate and curative resection rate were 94.5%(426/451),88.9%(401/451)and 87.1%(393/451)respectively.There was one case of micro perforation during operation(cured by endoscopic hemoclipping)(0.2%).There were 11 cases of delayed bleeding after operation(2.3%),of which 10 cases were cured by endoscopic hemostasis and 1 case was cured by surgical operation after emergency endoscopic hemostasis failure.And there were 2 cases of pyloric stenosis after operation(0.5%),both of which improved their condition after an expansion treatment.Follow-up visits were paid to 410 out of the 444 patients after ESD at the rate of 92.3%in 49.1months(13?109months).The visits found 5 fatality cases,and the total survival rate was 98.9%(439/444).The recurrence rate was 2.9%(13/451),and the average recurrence period was 17.6±9.6 months(6?38 months).A single-factor and multi-factor analysis indicated that a lesion bigger than 4.0cm(OR=10.855,P=0.012)is an independent risk factor in ESD treatment of HGIN and EGC postoperative recurrences.Conclusions:ESD treatament of EGC produces a high cure rate and a reduced recurrence rate,with a positive long-term effect.As the extent of disease increases,ESD postoperative recurrence rate rises.Therefore,postoperative monitoring of patients with bigger lesions should be intensified.