endoscopic examination and surgery for the pathological escalation of gastric low-grade intraepithelial neoplasia

胃低级别上皮内瘤变风险预测模型

Gastric cancer is one of the most common malignant tumors, especially in East Asia, with high incidence and mortality rates. It is one of the most common cancers in China, with new diagnoses and deaths accounting for about half of the global total1. It is a major cause of morbidity and mortality in the Chinese population2. Gastric cancer ranks third in the world in terms of the highest mortality rate among tumors, and its prognosis is highly dependent on the stage of the lesion1. The 5-year survival rate for advanced-stage patients is less than 30%, while the 5-year survival rate for early-stage patients is usually more than 90%. Therefore, early diagnosis and treatment of gastric cancer are essential to prevent and control the disease3. 
The Correa cascade reaction is widely recognized as one of the major patterns of gastric cancer development, suggesting that the carcinogenic process of gastric cancer gradually progresses from atrophic gastritis to intestinal metaplasia, intraepithelial neoplasia, and finally to adenocarcinoma4. With the application of modern technology and the increasing popularity of gastroscopy, an increasing number of gastric mucosal precancerous lesions have been detected, including magnifying endoscopy (ME), staining endoscopy, and narrow-band imaging (NBI)5. 
Low-grade intraepithelial neoplasia (LGIN) is one of the precancerous lesions of gastric cancer and is closely related to gastric cancer. However, some patients with low-grade intraepithelial neoplasia showed pathological upgrading after endoscopic submucosal dissection (ESD) compared with biopsy findings6. Therefore, there is some controversy in clinical practice regarding the choice of follow-up or treatment for patients with biopsy-proven LGIN. This article explores the risk factors for pathological upgrading after ESD treatment in patients with gastric LGIN establishes and evaluates a risk prediction model for LGIN occurrence, and provides more scientific and valuable reference opinions for the clinical management of gastric LGIN patients.

作者聚焦：推进胃肠道肿瘤的早期检测和治疗

胃低级别上皮内瘤变病理升级风险预测模型的建立与评价

The scope of our research is the detection, diagnosis, and treatment of earlier gastrointestinal tumors. The question I would like to answer is how to predict the risk of pathological escalation of gastric nuclei into epithelial nuclear in order to get the diagnosis and first treatment of patients. Recent developments in digestive endoscopy involve minimally invasive techniques, improve imaging modalities, revision biopsies and robot assisted certainly is, which improve diagnosis and terrible outcomes.In the future, we will focus our research scope on how to improve a diagnosis rate of early gastric cancer and includes the diagnostic envisions of early gastric cancer through artificial intelligence, as well as advanced endoscopic techniques.

胃低级别上皮内瘤变病理升级的内镜检查和手术

首先，准备内窥镜进行手术检查。将内窥镜从患者的嘴里插入，然后逐渐通过食道进入胃。观察消化道内部，检查粘膜中血管的颜色、形状、质地和分布，以确定可能的病变。使用ME-NBI技术，观察胃粘膜表面的微观结构以确定病变的程度。在白光内窥镜下定位病灶后，从远处放大到病灶中心附近。检查病变以确定是否存在分界线以及微血管和结构成分的各向异性程度。接下来，使用一次性粘膜切口刀沿病变边界制作电凝痕迹。用内窥镜注射针将准备好的生理盐水，肾上腺素和靛蓝胭脂溶液注射到粘膜下层。当病灶完全抬高时，从标记点开始在病灶周围做一个环形切口。然后从粘膜下解剖病变，直到完全切除。解剖后，仔细观察伤口。用电凝钳电凝伤口。完全切除后使用圈套器取出组织样本。在进一步的组织处理之前，将切除的针头固定在样品板上。

endoscopic-examination-surgery-for-pathological-escalation-gastric

Research

JoVE Journal

Cancer Research

Endoscopic Examination and Surgery for the Pathological Escalation of Gastric Low-Grade Intraepithelial Neoplasia

317 次观看.  Longyan First Affiliated Hospital of Fujian Medical University. 首先，准备内窥镜进行手术检查。将内窥镜从患者的嘴里插入，然后逐渐通过食道进入胃。观察消化道内部，检查粘膜中血管的颜色、形状、质地和分布，以确定可能的病变。使用ME-NBI技术，观察胃粘膜表面的微观结构以确定病变的程度。在白光内窥镜下定位病灶后，从远处放大到病灶中心附近。检查病变以确定是否存在分界线以及微血管和结构成分的各向异性程度。

视频: 胃低级别上皮内瘤变病理升级的内镜检查和手术

Establishment and Evaluation of a Risk Prediction Model for Pathological Escalation of Gastric Low-Grade Intraepithelial Neoplasia

The study aims to explore the risk factors for pathological escalation after endoscopic surgery for gastric low-grade intraepithelial neoplasia (LGIN) and to establish and evaluate a risk prediction model for LGIN. A total of 120 patients diagnosed with gastric LGIN by biopsy and endoscopic submucosal dissection (ESD) between November 2020 and June 2022 were retrospectively analyzed. Gender, age, Helicobacter pylori (HP) infection, lesion size, lesion location, morphology, gastric mucosal congestion, nodules status, surface ulceration and erosion, and ME-observation of all patients were collected and divided into upgraded and non-upgraded groups according to the biopsy and ESD postoperative pathological diagnosis results. Independent risk factors for pathological escalation after ESD surgical treatment were screened by logistic regression analysis, and a risk prediction model was established. Among the 120 patients with gastric LGIN, 49 patients developed postoperative pathological upgrading; the rate of pathological upgrading was 40.83%. Among them, 42 patients were upgraded to high-grade intraepithelial neoplasia (HGIN), 1 case was upgraded to advanced gastric cancer, and 6 cases were upgraded to early gastric carcinoma (EGC). Univariate analysis showed that age, lesion size, gastric mucosal congestion, surface ulcers, and erosion were significantly different between the groups (p &lt; 0.05). Multivariate Logistic regression analysis revealed that age &#8805;60 years, focal length &#8805;2 cm, gastric mucosal congestion, and surface ulceration and erosion were independent risk factors for postoperative pathological escalation in patients with gastric LGIN. Final joint probability forecasting model for P = 1/[1 + e(26.515-0.161 x &#946;1-0.357 x &#946;2+0.039 x &#946;3-0.269 x &#946;4)]. Age, lesion size &#8805;2 cm, gastric mucosal congestion, and lesion surface ulceration and erosion are risk factors for postoperative pathological upgrading in patients with gastric LGIN. The risk prediction model established in this study based on risk factors has predictive value and can provide a scientific reference for the clinical treatment of patients with gastric LGIN.

Here, we performed a systematic evaluation of patients diagnosed with gastric low-grade intraepithelial neoplasia by previous endoscopic biopsy and obtained a pathological diagnosis by complete resection of the lesion by endoscopic submucosal dissection (ESD), analyzing factors that potentially increase the risk of pathological escalation.

The study aims to explore the risk factors for pathological escalation after endoscopic surgery for gastric low-grade intraepithelial neoplasia (LGIN) and ...