Lee Young Bae, Han Jaeho, Cho Jeong Hyeon, Lee Hong Sub
Department of Internal Medicine, Seonam University College of Medicine, Myongji Hospital, Goyang, Korea.
Turk J Gastroenterol. 2016 Sep;27(5):421-427. doi: 10.5152/tjg.2016.16373.
BACKGROUND/AIMS: Although surveillance endoscopy is recommended after the treatment of a benign gastric ulcer in Korea, improved survival, secondary to an endoscopic follow-up strategy, is controversial. Thus, the aim of this study was to understand the results of gastric ulcer surveillance endoscopy and to individualize surveillance endoscopy by analyzing known risk factors for gastric cancer.
In total, 599 (M:F=424:175, median age=55.4 years) patients who were diagnosed with a gastric ulcer and who underwent follow-up endoscopy between January 2003 and August 2014 were retrospectively enrolled in this study. The final results and risk factors of follow-up endoscopy were analyzed.
Multivariate analysis of the data between the benign and malignant ulcer groups (benign: malignant=575:24) showed that an elevated border and irregular margins, among other risk factors, were significant indicators of malignancy (p<0.05). Of the 599 patients, 15 (2.5%) were histologically malignant based on the first biopsy results. Nine (1.5%) patients had malignant ulcers on surveillance endoscopy, and all nine were found to have atypia or dysplasia on the first biopsy. Eight of the nine patients had malignant endoscopic features.
Surveillance endoscopy for gastric ulcers may be unnecessary, except in cases of malignant and pre-malignant endoscopic features on the initial endoscopy.
背景/目的：在韩国，尽管建议对良性胃溃疡进行内镜监测，但内镜随访策略是否能提高生存率仍存在争议。因此，本研究的目的是了解胃溃疡监测内镜的结果，并通过分析已知的胃癌危险因素来实现监测内镜的个体化。
本研究回顾性纳入了2003年1月至2014年8月期间诊断为胃溃疡并接受随访内镜检查的599例患者（男:女 = 424:175，中位年龄 = 55.4岁）。分析了随访内镜的最终结果和危险因素。
对良性和恶性溃疡组数据（良性:恶性 = 575:24）的多因素分析显示，除其他危险因素外，边界抬高和边缘不规则是恶性的重要指标（p<0.05）。在599例患者中，根据首次活检结果，15例（2.5%）组织学为恶性。9例（1.5%）患者在监测内镜检查时发现恶性溃疡，且所有9例在首次活检时均发现有异型增生或发育异常。9例患者中有8例具有恶性内镜特征。
除初次内镜检查发现恶性和癌前内镜特征的情况外，胃溃疡的监测内镜检查可能不必要。
