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

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Abstract

Background

Treatment with endoscopic submucosal dissection (ESD) for gastric category 3 lesion (low grade dysplasia, LGD) diagnosed by endoscopic forceps biopsy (EFB) is controversial.

Aims

The 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.

Methods

Between 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.

Results

Pathologic 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.

Conclusions

Endoscopic 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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Acknowledgments

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A091047).

Conflict of interest

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Authors and Affiliations

  1. 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, Beomeo-ri, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Korea

    Cheol Woong Choi, Hyung Wook Kim, Dae Hwan Kang, Yong Mi Hong, Jin Hyun Park, Su Bum Park & Mong Cho

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

    Dong Hoon Shin & Jung Hee Lee

Authors
  1. Cheol Woong Choi
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  2. Hyung Wook Kim
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  3. Dong Hoon Shin
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  4. Dae Hwan Kang
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  5. Yong Mi Hong
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  6. Jin Hyun Park
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  7. Su Bum Park
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  8. Mong Cho
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  9. Jung Hee Lee
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Corresponding author

Correspondence to Dae Hwan Kang.

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Choi, C.W., Kim, H.W., Shin, D.H. et al. The Risk Factors for Discrepancy After Endoscopic Submucosal Dissection of Gastric Category 3 Lesion (Low Grade Dysplasia). Dig Dis Sci 59, 421–427 (2014). https://doi.org/10.1007/s10620-013-2874-8

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  • DOI: https://doi.org/10.1007/s10620-013-2874-8

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