| Objectives:To analysis the Endoscopic Submucosal Dissection technique(Endoscopic Submucosal Dissection,ESD)treatment of gastric mucosal lesions and Submucosal tumors(Submucosal tumors,SMTs)the efficacy and safety.Methods:This paper retrospectively analyzed 140 patients admitted by The fourth affiliated hospital of kunming medical university to receive ESD treatment due to gastric mucosal lesions and SMTs from January 2016 to December 2019.Clinical data of patients were recorded in detail,such as gender,age,lesion site,lesion size,ultrasonic level,complications,and pathological types of ESD specimens.The independent risk factors of ESD complications were analyzed by multivariate unconditional Logistic regression using SPSS23.0 software.Results:The success rate of ESD surgery was 100%(140/140),the whole resection rate of lesions was 92.14%(129/140),and the total resection rate was 93.57%(131/140).In this study,all 140 patients successfully completed ESD treatment.A total of 129 cases were removed by lumps under endoscope,and the overall lumps resection rate was 92.14%(129/140).The resection rates of mucosal lesions or SMTs in cardia,fundus,gastric body,antrum and gastric corner were 100%(8/8),95.45%(21/22),85.19%(23/27),93.83%(76/81)and 50.00%(1/2),respectively.There was no statistical significance between the resection rates of lesions in different parts(P>0.05).The rate of complete resection was 93.57%(131/140).The rates of complete resection of mucosal lesions in cardia,fundus,gastric body,gastric antrum and gastric Angle or SMTs were 100%(8/8),95.45%(21/22),92.59%(25/27),92.59%(75/81)and 100%(2/2),respectively.There was no statistical significance between the rates of complete resection of lesions in different parts(P>0.05).Moreover,there was no statistical significance between the whole resection rate and the complete resection rate of different pathological types(heterotopic pancreas,leiomyoma,stromal tumor)(P>0.05).The lesions were divided into lump-resection group and non-lump-resection group according to whether the lesions were removed by lump-resection under endoscope.In the lump-resection group,the lesion size was 1.08±0.79cm VS 1.66±1.46cm in the non-lump-resection group,showing no statistical significance(P>0.05).The lump-cut rates of mucosal layer,mucosal muscle layer,submucosal layer and intrinsic muscle layer were 95.45%(21/22),82.35%(14/17),94.12%(64/68)and 90.91%(30/33),respectively.There was no statistical significance in the comparison of lump-cut rates of lesions at different ultrasonic levels(P>0.05).Among 140 patients with gastric mucosal lesions or SMTs,the incidence of bleeding during ESD was 34.29%(48/140),the incidence of perforation during ESD was 7.14%(10/140),and the incidence of delayed bleeding after ESD was 3.57%(5/140).According to the occurrence of intraoperative hemorrhage,it was divided into intraoperative hemorrhage group and intraoperative non-hemorrhage group.The proportion of all parts in the intraoperative hemorrhage group was 14.58%(7/48)of cardiac lesions,31.25%(15/48)of gastric fundus lesions,35.42%(17/48)of gastric body lesions,4.17%(2/48)of gastric Angle lesions,and 14.58%(7/48)of gastric antrum lesions.The proportion of each ultrasonic level in the intraoperative hemorrhage group was 14.58%(7/48),27.08%(13/48),22.92%(11/48),and 35.42%(17/48)in the mucosal layer lesions,respectively.There was statistical significance in the lesion site and ultrasonic level between the two groups(P<0.05).The size of intraoperative hemorrhage group was 1.19±1.21cm VS the size of intraoperative non-hemorrhage group was 1.09±0.63cm.The operative time in the intraoperative hemorrhage group was 45.69±11.20min VS 45.16±23.98min in the non-operative hemorrhage group,and there was no statistical significance in terms of lesion size and operative time between the two groups(P>0.05).Risk factors of hemorrhage during ESD:lesion site and ultrasonic level were used as independent variables for Logistic regression analysis.Lesion site(P>0.05 OR:1.022 95%CI:0.737-1.417)and ultrasonic level(P>0.05 OR:0.99095%CI:0.690-1.420)were non-independent risk factors for hemorrhage during ESD.Intraoperative perforation group was divided into intraoperative perforation group and intraoperative non-perforation group according to the intraoperative perforation or not.The proportion of each part in the intraoperative perforation group was 0%(0/10)of cardiac lesions,60%(6/10)of gastric fundus lesions,40%(4/10)of gastric body lesions,0%(0/10)of gastric Angle lesions,and 0%(0/10)of gastric antrum lesions.The proportion of each ultrasonic level was 0%(0/10)in the mucosal layer,10%(1/10)in the mucosal muscle layer,0%(0/10)in the submucosal layer,and 90%(9/10)in the intrinsic muscle layer.The operative time in the operative perforation group was 63.30±30.40min VS 43.90±18.97min in the operative non-perforation group.The comparison between the two groups was statistically significant in terms of lesion site,ultrasonic level and operation time(P<0.05).The intraoperative perforation group had a lesion size of 1.55±1.03cm VS the intraoperative non-perforation group had a lesion size of 1.09±0.85cm.There was no significant difference between the two groups in the size of the lesion(P>0.05).Risk factors for ESD perforation:lesion site,ultrasonic level and operation time were used as independent variables for Logistic regression analysis.Lesion site(P>0.05 OR:1.093 95%CI:0.622-1.921)was a non-independent risk factor for ESD perforation.Ultrasound level(P<0.05 OR:11.12 95%CI:2.349-52.601)and operation time(P<0.05 OR:1.023 95%CI:1.001-1.045)were independent risk factors for perforation during ESD surgery.Conclusions:1.ESD treatment of gastric mucosal lesions and SMTs has a high overall resection rate and complete resection rate,and is minimally invasive with few complications.2.The lesion site and ultrasonic level are risk factors for hemorrhage during ESD operation and non-independent risk factors for hemorrhage during ESD operation.3.Ultrasonic level and operation time are independent risk factors for ESD perforation. |
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