A Comparative Study On The Pathological Upgrade After Endoscopic Submucosal Dissection Of Gastric Mucosa With High-grade Intraepithelial Neoplasia

Objective:Through relevant data analysis and research,the reasons for the pathological upgrade of gastric mucosal high-grade intraepithelial neoplasia after endoscopic submucosal dissection were further analyzedMethods:Randomly assigned 113 cases from January 2016 to December 2019 in Changzhou City First People's Hospital of digestive department performed endoscopic submucosal dissection(ESD),were perfect preoperative endoscopic biopsy and pathologic diagnosis of gastric mucosa high-grade intraepithelial neoplasia(HGIN),collect the relevant data and through statistical method for preoperative and postoperative diagnosis and its influencing factors were analyzed,and it is concluded that the cause of postoperative pathologic upgrade.Results:Of the 113 patients,56 had the same postoperative pathology,and 57 had the final pathological diagnosis upgraded to cancer,with an upgrade rate of 50.4%and no pathological degradation.Based on the pathological results after ESD operation,the cases were divided into HGIN group and gastric cancer group.The study showed that there were no statistical significances between the 2 groups in age(t=0.872,P=0.385),lesion site(x2=3.697,P=0.296),lesion shape(x2=2.756,P=0.737),redness of lesion surface(x2=0.078,P=0.780)and HP infection(x2=0.202,P=0.653).Single factor analysis showed that there are differences between groups of gender(x2=6.853,P=0.009),and the size of the lesions(t=3.241,P=0.002)and the lesion surface concave/ulcer(x2=4.062,P=0.044)and other factors,as after multiariable logistic regression analysis found that the lesion size 3 cm or larger(OR=0.261,95%CI:0.111-0.614,P=0.002),and male(OR=3.371,95%CI:1.149-9.889,P=0.027)were independent risk factors for pathological progression after endoscopic resection of gastric mucosa with high-grade intraepithelial neoplasia.Conclusion:Gastric mucosa high-grade intraepithelial neoplasia compared to traditional white light endoscopic biopsy with the actual situation there is underestimated,the lesion size of 3 cm or larger,especially male,are the main risk factors,pathological upgrade should suggest lines of endoscopic submucosal dissection technique further evaluation of the property of lesions,provide accurate basis for the next treatments.