Published online Jun 28, 2017. doi: 10.3748/wjg.v23.i24.4407
Peer-review started: February 17, 2017
First decision: March 22, 2017
Revised: April 4, 2017
Accepted: May 19, 2017
Article in press: May 19, 2017
Published online: June 28, 2017
Processing time: 129 Days and 23.1 Hours
To determine the gastric adenocarcinoma (GAC) occurrence rate and related factors, we evaluated the follow-up results of patients confirmed to have gastric dysplasia after endoscopic resection (ER).
We retrospectively analyzed the medical records, endoscopic examination records, endoscopic procedure records, and histological records of 667 cases from 641 patients who were followed-up for at least 12 mo, from among 1273 patients who were conformed to have gastric dysplasia after Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of gastric mucosal lesions between January 2007 and August 2013 at the Chungnam National University Hospital.
The mean follow-up period was 33.8 mo, and the median follow-up period was 29 mo (range: 12-87). During the follow-up period, the occurrence of metachronous GAC was 4.0% (27/667). The mean and median interval periods between the occurrence of metachronous GAC and endoscopic treatment of gastric dysplasia were 36.3 and 34 mo, respectively (range: 16-71). The factors related to metachronous GAC occurrence after ER for gastric dysplasia were male sex (5.3% vs 1.0%), open-type atrophic gastritis (9.5% vs 3.4%), intestinal metaplasia (6.8% vs 2.4%), and high-grade dysplasia (HGD; 8.4% vs 3.2%). Among them, male sex [OR: 5.05 (1.18-21.68), P = 0.029], intestinal metaplasia [OR: 2.78 (1.24-6.23), P = 0.013], and HGD [OR: 2.70 (1.16-6.26), P = 0.021] were independent related factors in multivariate analysis. Furthermore, 24 of 27 GAC cases (88.9%) occurred at sites other than the previous resection sites, and 3 (11.1%) occurred at the same site as the previous resection site.
Male sex, intestinal metaplasia, and HGD were significantly related to the occurrence of metachronous GAC after ER of gastric dysplasia, and most GACs occurred at sites other than the previous resection sites.
Core tip: Gastric dysplasia is considered a premalignant lesion that can become malignant. Thus, endoscopic resection is preferred not only for the removal of these lesions but also for exact diagnosis. In our study, we investigated the relationship between the occurrence of synchronous and metachronous lesions after endoscopic treatment of gastric dysplasia and various clinical factors during the follow-up period. The incidence rates of synchronous and metachronous neoplasms after endoscopic resection of gastric dysplasia were 12.1% and 13.8%, respectively. In the multivariate analysis, age of < 60 years and intestinal metaplasia were independent risk factors of synchronous neoplasm. For metachronous neoplasm, especially metachronous gastric adenocarcinoma, independent risk factors were male sex, intestinal metaplasia, and high-grade dysplasia.