Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification R1 김진숙 / Prof. 장재영 Endoscopy 2011; 43:

Introduction Gastric adenoma/dysplasiaGastric carcinoma histologic gr of dysplasia Complete endoscopic or surgical resection highly recommended Therapeutic guidelines unestablished to evaluate risk factors associated with invasive carcinoma/HGD in LGD lesions removed by endoscopic rescection and classified by the Vienna system

Patients & Methods Study population and evaluation of endoscopic features –Jan 2004 ~ Dec 2008, retrospective, off the pathology database –at National Cancer Center Hospital, 4 endoscopists participated –2~4 biopsy specimens obtained per suspected lesion –Excluded: recurrent adenoma at a previous endoscopic resection site Gross typesSurface configuration Erythema: red discoloration on the mucosal surface of the lesion compared to the surrounding mucosa Nodularity: presence of irregularity raised or nodular mucosa Erosion Ulceration Converging folds or deformity of the muscularis propria, or fibrosis of the submucosa Location Gastric Area: Upper, middle, lower Cross-sectional circumference : GC, LC, ant. & post. wall

Endoscopic resection procedure all lesions removed by; –Strip-off biopsy method –EMR using a cap –EMR with pre-cutting –ESD Resection -En bloc resection: the tumor resected in a single piece -Complete resection: resected tumor had tumor-free lateral and deep margins Complications -Immediate bleeding vs. Delayed bleeding (24h) -Microperforation vs. Macroperforation Histologic examination and H.pylori test –By a single pathologist –Hematoxylin-eosin and Wright-Giemsa staining –Bx done at LC of the antrum and of the body, GC of the body + corpus GC for rapid urease test – H. pylori infection if rapid urease test (+) or Sydney system (+) Statistical analysis –Baseline characteristics compared using chi2 and Student’s t-test -> SPSS –Risk factors identified using GEE logistic regression model

Results 290 LGD (260 patients) Recurrent adenoma (- 8) Argon plasma coagulation (- 46) 236 LGD (208 patients) Strip-off biopsy 10 (4.2%) EMR-P 49 (20.8%) EMR-C 7 (3.0%) ESD 170 (72.0%)

Histology of resected specimens Results

Demographic characteristics and endoscopic findings Results

Multivariate analysis Results

Sensitivity, specificity, accuracy and positive and negative predictive values Results

Rates of en bloc resection and complete resection, complications of endoscopic resection, and follow-up -Complications: Bleeding – immediate (0.4%; 1), delayed (1.3%; 3) Perforation – micro (2; medication), macro (1; managed by endoscopic clipping) -Follow-up: -3 had local recurrence : 2 developed HGD (Vienna category 3.0) : 1 developed HGD (Vienna category 4.1) Results

Conclusion LGD : Endoscopic resection recommended at least one of the following risk factor 1) Depressed morphology 2) Surface erythema 3) Size of 1cm or greater None of the three risk factors  f/u endoscopy is recommened