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

Gastric Low-Grade Intraepithelial Neoplasia의 위험 예측 모델

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.

저자 스포트라이트: 위장관 종양의 조기 발견 및 치료 발전

위 저등급 상피내 종양의 병리학적 에스컬레이션을 위한 위험 예측 모델 구축 및 평가

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.

위 저등급 상피내 종양의 병리학적 증식을 위한 내시경 검사 및 수술

시작하려면 수술 검사를 위해 내시경을 준비하십시오. 내시경을 환자의 입을 통해 삽입하고 식도를 통해 위장으로 서서히 전진시킵니다. 소화관 내부를 관찰하고 점막에 있는 혈관의 색, 모양, 질감 및 분포를 검사하여 가능한 병변을 식별합니다.ME-NBI 기술을 사용하여 위 점막 표면의 미세 구조를 관찰하여 병변의 범위를 결정합니다. 백색광 내시경 검사로 병변을 찾은 후 먼 곳에서 병변 중앙 근처까지 확대합니다. 병변을 검사하여 경계선이 존재하는지, 미세혈관 및 구조적 구성 요소의 이방성 정도를 확인합니다.다음으로, 일회용 점막 절개 칼을 사용하여 병변 경계를 따라 전기 응고 표시를 만듭니다. 준비된 식염수, 에피네프린, 인디고 루즈를 내시경 주사 바늘로 점막하 부분에 주입합니다. 병변이 완전히 융기되면 표시 지점에서 병변 주위를 원주 절개합니다.그런 다음 병변이 완전히 제거될 때까지 점막하 종양을 절개합니다. 해부 후 상처를 주의 깊게 관찰하십시오. 전기 응고 겸자로 상처를 전기 응고시킵니다.스네어를 사용하여 완전한 절제 후 조직 샘플을 제거합니다. 추가 조직 처리 전에 절제된 바늘을 샘플 보드에 고정합니다.

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 조회수.  Longyan First Affiliated Hospital of Fujian Medical University. 시작하려면 수술 검사를 위해 내시경을 준비하십시오. 내시경을 환자의 입을 통해 삽입하고 식도를 통해 위장으로 서서히 전진시킵니다. 소화관 내부를 관찰하고 점막에 있는 혈관의 색, 모양, 질감 및 분포를 검사하여 가능한 병변을 식별합니다.ME-NBI 기술을 사용하여 위 점막 표면의 미세 구조를 관찰하여 병변의 범위를 결정합니다. 백색광 내시경 검사로 병변을 찾은...

비디오: 위 저등급 상피내 종양의 병리학적 증식을 위한 내시경 검사 및 수술

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 ...