Pathological Difference Between Endoscopic Forceps Biopsy And Endoscopic Resection In Esophageal Intraepithelial Neoplasia And Evaluate The Efficacy Of Endoscopic Submucosal Dissection

Background:The prognosis of esophageal cancer is significantly correlated with the stage,and endoscopy is the preferred method for the diagnosis of early esophageal cancer(EEC).The patient with EEC had high quality of life after endoscopic resection compared with surgery.At present,the diagnosis rate of EEC in China is only 10%,which needs to be further improved.Objective:Analyzed the difference of histopathologic characteristics between endoscopic forceps biopsy(EFB)and endoscopic resection(ER)in esophageal intraepithelial neoplasia(IEN).And explored the value of endoscopic submucosal dissection(ESD)in the diagnosis and treatment of IEN.Methods: From January 2014 to December 2018 in digestive endoscopy center of Taihe hospital,a total of 340 lesions diagnosed as IEN or EEC by EFB and treated with ESD were enrolled.A detailed histologic analysis was performed for each ER and EFB to exploring the risk factors for pathological upgrade after ER.And evaluating the efficacy of ESD in IEN.Results:According to the histological types of the EFB specimens,there were 88 lesions with low-grade intraepithelial neoplasia(LGIN),207 with high-grade intraepithelial neoplasia(HGIN)and 45 with EEC.Although concordant in most(66.2%)cases between EFBs and gold standard,pathological diagnoses in 150(33.8%)cases were upgraded in EFBs.The concordance rate of38.6%(34/88)for LGIN,70.5%(146/207)for HGIN and 100.0%(45/45)for EEG was found significantly(P<0.001).Compared to the concordant group,the surface nodularity,target biopsy using iodine staining or narrow-band imaging(NBI)or endoscopic ultrasonography(EUS)and largest diameter of lesion were associated with pathologic upgrade to advanced diseases in ER.In the evaluate of the efficacy and complication of ESD,the enblock resection rate was 97.4%(331/340),the complete resection rate was 90.9%(309/340),and the curative resection rate was 85.6%(291/340).During the operation,15 patients used endoscopic clips to seal the wound due to deepwound dissection.The average number of endoscopic clips used was 2.The incidence of postoperative delayed bleeding was 2.94%(10/340),the incidence of postoperative esophageal perforation was 5.29%(18/340),and the incidence of postoperative fever was 2.65%(9/340),among which the incidence of perforation was positively correlated with the severity of the lesion(P<0.05).Conclusion:EFB was insufficient for a definitive diagnosis in patients with IEN or EEC.Pathological upgrading of LGIN was common,so biopsy using iodine staining or NBI or EUS is of significant importance to improve diagnostic accuracy for mucosa with larger diameter and nodular lesion.Therefore,ESD is security and effective in the treatment of IEN and EEC.