The Risk Factors for Discrepancy After Endoscopic Submucosal Dissection of Gastric Category 3 Lesion (Low Grade Dysplasia) View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2013-12-24

AUTHORS

Cheol Woong Choi, Hyung Wook Kim, Dong Hoon Shin, Dae Hwan Kang, Yong Mi Hong, Jin Hyun Park, Su Bum Park, Mong Cho, Jung Hee Lee

ABSTRACT

BackgroundTreatment with endoscopic submucosal dissection (ESD) for gastric category 3 lesion (low grade dysplasia, LGD) diagnosed by endoscopic forceps biopsy (EFB) is controversial.AimsThe purpose of the present study was to validate the use of ESD for gastric LGD diagnosed by EFB and to evaluate predictable factors for pathologic upgrade diagnosis to category 4 (high grade dysplasia, HGD) or 5 (early gastric cancer, EGC) lesions.MethodsBetween November 2008 and October 2011, a retrospective analysis of a prospective database was conducted at a single tertiary referral center. A total of 218 ESD procedures were carried out for gastric LGD lesions identified by EFB. The under-diagnosis rate by EFB and the predictable factors for upgrade diagnosis to category 4 or 5 lesions were analyzed.ResultsPathologic discrepancy between EFB and surgical resection was 20.1 % (44/218). Thirty eight lesions (17.4 %) were diagnosed HGD or EGC by ESD. Gastric HGD lesions were 14 cases (6.4 %) and EGC lesions were 24 cases (23 mucosal and 1 submucosal cancer) (11.0 %). Multivariate analysis revealed that lesion diameter more than 1 cm (OR 3.496 [95 % CI 1.375–8.849]), surface redness (OR 6.493 [95 % CI 2.557–16.666]) and nodular surface (OR 2.762 [95 % CI 1.237–6.172]) were significant risk factors.ConclusionsEndoscopic resection can be recommended if a LGD lesion has risk factors such as a size of 1 cm or greater, surface redness or surface nodulariy. For lesions without the risk factors, follow-up endoscopy may be recommended. More... »

PAGES

421-427

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10620-013-2874-8

DOI

http://dx.doi.org/10.1007/s10620-013-2874-8

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1038578415

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24366779


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31 schema:description BackgroundTreatment with endoscopic submucosal dissection (ESD) for gastric category 3 lesion (low grade dysplasia, LGD) diagnosed by endoscopic forceps biopsy (EFB) is controversial.AimsThe purpose of the present study was to validate the use of ESD for gastric LGD diagnosed by EFB and to evaluate predictable factors for pathologic upgrade diagnosis to category 4 (high grade dysplasia, HGD) or 5 (early gastric cancer, EGC) lesions.MethodsBetween November 2008 and October 2011, a retrospective analysis of a prospective database was conducted at a single tertiary referral center. A total of 218 ESD procedures were carried out for gastric LGD lesions identified by EFB. The under-diagnosis rate by EFB and the predictable factors for upgrade diagnosis to category 4 or 5 lesions were analyzed.ResultsPathologic discrepancy between EFB and surgical resection was 20.1 % (44/218). Thirty eight lesions (17.4 %) were diagnosed HGD or EGC by ESD. Gastric HGD lesions were 14 cases (6.4 %) and EGC lesions were 24 cases (23 mucosal and 1 submucosal cancer) (11.0 %). Multivariate analysis revealed that lesion diameter more than 1 cm (OR 3.496 [95 % CI 1.375–8.849]), surface redness (OR 6.493 [95 % CI 2.557–16.666]) and nodular surface (OR 2.762 [95 % CI 1.237–6.172]) were significant risk factors.ConclusionsEndoscopic resection can be recommended if a LGD lesion has risk factors such as a size of 1 cm or greater, surface redness or surface nodulariy. For lesions without the risk factors, follow-up endoscopy may be recommended.
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42 ESD procedure
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49 cases
50 category 3 lesions
51 category 4
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57 dissection
58 endoscopic forceps biopsy
59 endoscopic submucosal dissection
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61 factors
62 forceps biopsy
63 lesion diameter
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