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Long-term natural history after endoscopic resection for gastric dysplasia

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Abstract

Background and study aims

Natural history after endoscopic resection (ER) for gastric dysplasia is still unclear. The aim of this study was to evaluate the long-term clinical outcomes and risk factors after ER for gastric dysplasia between control and cases with synchronous or metachronous gastric neoplasm.

Methods

A total of 1090 patients who had undergone ER for gastric dysplasia and been followed up for at least one year from December 2002 to December 2013 were finally analyzed. Risk factors affecting the development of synchronous or metachronous neoplasm (SMN) and long-term clinical outcomes after ER for gastric dysplasia were evaluated.

Results

Synchronous and metachronous neoplasms had developed in 126 (11.6%) and 133 patients (12.2%) during the mean follow-up duration of 63.6 months, respectively. Five-year and 10-year risk of metachronous neoplasm were 9.8% and 27.2%, respectively. Median duration to the development of metachronous neoplasm was 103.1 months. While age (P < 0.001) and mucosal atrophy (P = 0.09) of index cases were associated with the development of synchronous neoplasm, age (P = 0.017), incomplete resection (P = 0.025), and intestinal metaplasia (P = 0.017) of background mucosa of index cases were significantly related to the development of metachronous neoplasm in multivariate analysis. Cumulative incidence of SMN was not significantly different among H. pylori negative, eradicated, and persistent group.

Conclusions

Age, incomplete ER, and background intestinal metaplasia of index gastric dysplasia were significantly associated with metachronous recurrence. Endoscopic surveillance for metachronous recurrence after ER for gastric dysplasia is mandatory for longer than 10 years.

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Abbreviations

OR:

Odds ratio

CI:

Confidence interval

EGC:

Early gastric cancer

SMN:

Synchronous or metachronous neoplasm

H. pylori :

Helicobacter pylori

ER:

Endoscopic resection

ESD:

Endoscopic submucosal dissection

EMR:

Endoscopic mucosal resection

APC:

Argon plasma coagulation

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Acknowledgements

Jue Lie Kim and Sang Gyun Kim involved in analysis and interpretation of the data and drafted the article; Jue Lie Kim, Sang Gyun Kim, Ayoung Lee, Jinju Choi, Hyunsoo Chung, and Soo-Jeong Cho did critical revision of the article for important intellectual content; Sang Gyun Kim contributed to the final approval of the article.

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Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Jue Lie Kim, Sang Gyun Kim, Ayoung Lee, Jinju Choi, Hyunsoo Chung & Soo-Jeong Cho

  2. Daehangno 101, Jongno-gu, Seoul, 03080, South Korea

    Sang Gyun Kim

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  1. Jue Lie Kim
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Correspondence to Sang Gyun Kim.

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Disclosures

This work was supported by a Grant (NRF-2017R1D1A1B03036304) of the Basic Science Research Program through the National Research Foundation (NRF) funded by the Ministry of Education and a grant from Liver Research Institute, Seoul National University College of Medicine, Republic of Korea. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors do not have no conflicts of interest or financial ties to disclose.

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Kim, J.L., Kim, S.G., Lee, A. et al. Long-term natural history after endoscopic resection for gastric dysplasia. Surg Endosc 35, 5247–5255 (2021). https://doi.org/10.1007/s00464-020-08023-3

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