Is lesion size an independent indication for endoscopic resection of biopsy-proven low-grade gastric dysplasia? Kim MK, Jang JY, Kim JW, Shim JJ, Lee CK, Chang YW, Choe BK. Dig Dis Sci. 2014 Feb;59(2):428-35.
BACKGROUND/AIM: The standard treatment for patients with gastric low-grade dysplasia (LGD) remains controversial, even though diagnosis of LGD is increasingly common as esophagogastrodeuodenoscopy becomes more available. The aim of this study was to identify a lesion size cut-off as an indication for endoscopic resection (ER) for patients with LGD.
RESULTS: We retrospectively reviewed 285 lesions initially diagnosed as LGD by endoscopic forceps biopsies (EFB) from 2007 to 2010 in Kyung Hee University Hospital, Seoul, Korea. All patients underwent ER. A total of 285 lesions from 257 patients were assessed. After ER, 239 LGD (83.9 %) showed histological concordance and the remaining 46 (16.1 %) cases revealed an upgraded histology [22 high-grade dysplasia (7.7 %), and 24 differentiated adenocarcinoma (8.4 %)]. Univariate analyses demonstrated that lesion size, erythema, depression, and erosion were significant predictors of upgraded LGD (P < 0.001). Multivariate analysis showed that a lesion size ≥2 cm, erythema, and a depressed-type lesion were independent predictors of upgraded histology (P = 0.014, odds ratio 3.27, 95 % confidence interval 1.28-8.39).
CONCLUSIONS: Our data suggest that a substantial number of LGD diagnoses based on EFB were not representative of the entire lesion. We recommend ER if gastric LGD has at least one of the following risk factors: surface erythema and a depressed type regardless of size, or ≥2 cm size regardless of abnormal surface configuration.Leggi l’articolo