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Predictors of upstage diagnosis after endoscopic resection of gastric low-grade dysplasia

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Abstract

Background

The optimal management of precursor lesions such as gastric low-grade dysplasia is crucial in order to improve gastric cancer-related mortality. However, there are no universally accepted management guidelines regarding which lesions should be resected or should be monitored by follow-up visits.

Patients and methods

We retrospectively analyzed data from 1006 gastric low-grade dysplasia lesions that had been resected via endoscopic submucosal dissection. We also evaluated the endoscopic risk factors associated with upstage diagnosis from low-grade dysplasia to high-grade dysplasia or gastric cancer.

Results

The mean age of our patients was 63.7 ± 9.1 years and 70.3% of our study population included men. The predominant location and gross type of lesions was the lower third of the stomach (78.6%) and the elevated type (57.8%), respectively. The rates of pathological concordance, upstage, and downstage diagnosis were 85.3, 12.1, and 2.6%, respectively. Multivariate analysis, after adjusting for age and sex, showed that a lesion size ≥ 10 mm (Odds ratio [OR] 2.231; p = 0.003), erythema (OR 7.315; p < 0.001), nodularity (OR 5.589; p < 0.001), depression (OR 3.024; p = 0.002), and erosion (OR 7.680; p < 0.001) were all factors significantly associated with upstage diagnosis. Furthermore, an increasing number of risk factors was associated with an increasing frequency of upstage diagnosis; if there were no risk factors, then there was no upstage diagnosis.

Conclusions

This study identified several risk factors that were significantly associated with the upstage diagnosis of gastric low-grade dysplasia: lesion size ≥ 10 mm and a variety of surface changes (erythema, nodularity, depression, and erosion). Our data indicate that if there is no evidence of these endoscopic risk factors, then regular follow-up may be considered, according to the patient’s combined comorbid conditions.

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Authors and Affiliations

  1. Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea

    Dae Hwan Kang, Cheol Woong Choi, Hyung Wook Kim, Su Bum Park, Su Jin Kim, Hyeong Seok Nam & Dae Gon Ryu

  2. Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea

    Cheol Woong Choi

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  1. Dae Hwan Kang
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Correspondence to Cheol Woong Choi.

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Disclosures

Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Su Jin Kim, Hyeong Seok Nam, and Dae Gon Ryu have no conflicts of interest or financial ties to disclose.

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Kang, D.H., Choi, C.W., Kim, H.W. et al. Predictors of upstage diagnosis after endoscopic resection of gastric low-grade dysplasia. Surg Endosc 32, 2732–2738 (2018). https://doi.org/10.1007/s00464-017-5971-5

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  • DOI: https://doi.org/10.1007/s00464-017-5971-5

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