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Risk stratification of patients with gastric lesions indefinite for dysplasia

The Korean journal of internal medicine, 2021-09, Vol.36 (5), p.1074-1082 [Peer Reviewed Journal]

COPYRIGHT(C) KYOBO BOOK CENTRE ALL RIGHTS RESERVED ;ISSN: 1226-3303 ;EISSN: 2005-6648

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  • Title:
    Risk stratification of patients with gastric lesions indefinite for dysplasia
  • Author: Young Sin Cho ; Il-kwun Chung ; Yunho Jung ; Su Jung Han ; Jae Kook Yang ; Tae Hoon Lee ; Sang-heum Park ; Sun-joo Kim
  • Subjects: Follow-up studies ; Gastroscopy ; Precancerous conditions ; Risk factors ; Stomach neoplasms
  • Is Part Of: The Korean journal of internal medicine, 2021-09, Vol.36 (5), p.1074-1082
  • Description: Background/Aims: There are no definite guidelines for the management of gastric lesions diagnosed as indefinite for dysplasia (IND) by endoscopic forceps biopsy (EFB). Therefore, this study aimed to evaluate the clinical outcomes of gastric IND and predictive factors for gastric neoplasm. Methods: This study included 457 patients with a first diagnosis of gastric IND by EFB between January 2005 and December 2013. Patient characteristics and endoscopic and pathological data were reviewed and compared. Results: Of the 457 gastric IND patients, 128 (28%) were diagnosed with invasive carcinoma, 21 (4.6%) with high-grade dysplasia, 31 (6.8%) with low-grade dysplasia, and 277 (60.6%) as negative for dysplasia. Of lesions observed, 180 (39.4%) showed upgraded histology. Multivariate analysis revealed that surface erythema (odds ratio [OR], 2.804; 95% confidence interval [CI], 1.741 to 4.516), spontaneous bleeding (OR, 2.618; 95% CI, 1.298 to 5.279), lesion size ≥ 1 cm (OR, 5.762; 95% CI, 3.459 to 9.597), and depressed morphology (OR, 2.183; 95% CI, 1.155 to 4.124) were significant risk factors for high-grade dysplasia or adenocarcinoma. The ORs associated with 2 and ≥ 3 risk factors were 7.131 and 34.86, respectively. Conclusions: Precautions should be taken in the management of gastric IND patients, especially when risk factors, including surface erythema, spontaneous bleeding, lesion size ≥ 1 cm, and depressed morphology are present. Considering the combined effect of the presence of multiple risk factors on the incidence of high-grade dysplasia or adenocarcinoma, endoscopic resection should be recommended if a gastric IND patient has at two or more of these factors.
  • Publisher: 대한내과학회
  • Language: Korean
  • Identifier: ISSN: 1226-3303
    EISSN: 2005-6648
  • Source: KoreaMed Synapse
    PubMed Central
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    ROAD: Directory of Open Access Scholarly Resources
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