Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
, Daehangno 101, Jongno-gu, Seoul, 03080, South Korea.
Surg Endosc. 2021 Sep;35(9):5247-5255. doi: 10.1007/s00464-020-08023-3. Epub 2020 Sep 28.
Natural history after endoscopic resection (ER) for gastric dysplasia is still unclear. The aim of this study was to evaluate the long-term clinical outcomes and risk factors after ER for gastric dysplasia between control and cases with synchronous or metachronous gastric neoplasm.
A total of 1090 patients who had undergone ER for gastric dysplasia and been followed up for at least one year from December 2002 to December 2013 were finally analyzed. Risk factors affecting the development of synchronous or metachronous neoplasm (SMN) and long-term clinical outcomes after ER for gastric dysplasia were evaluated.
Synchronous and metachronous neoplasms had developed in 126 (11.6%) and 133 patients (12.2%) during the mean follow-up duration of 63.6 months, respectively. Five-year and 10-year risk of metachronous neoplasm were 9.8% and 27.2%, respectively. Median duration to the development of metachronous neoplasm was 103.1 months. While age (P < 0.001) and mucosal atrophy (P = 0.09) of index cases were associated with the development of synchronous neoplasm, age (P = 0.017), incomplete resection (P = 0.025), and intestinal metaplasia (P = 0.017) of background mucosa of index cases were significantly related to the development of metachronous neoplasm in multivariate analysis. Cumulative incidence of SMN was not significantly different among H. pylori negative, eradicated, and persistent group.
Age, incomplete ER, and background intestinal metaplasia of index gastric dysplasia were significantly associated with metachronous recurrence. Endoscopic surveillance for metachronous recurrence after ER for gastric dysplasia is mandatory for longer than 10 years.
内镜下胃黏膜切除术（endoscopic resection，ER）后胃黏膜异型增生的自然病程仍不清楚。本研究旨在评估胃黏膜异型增生内镜下切除后，无同步或异时性胃肿瘤（synchronous or metachronous gastric neoplasm，SMN）与存在同步或异时性胃肿瘤病例之间的长期临床结局及其危险因素。
共分析了 1090 例 2002 年 12 月至 2013 年 12 月接受 ER 治疗且随访至少 1 年的胃黏膜异型增生患者，评估影响胃黏膜异型增生 ER 后同步或异时性肿瘤（synchronous or metachronous neoplasm，SMN）发生及长期临床结局的危险因素。
在平均 63.6 个月的随访期间，126 例（11.6%）和 133 例（12.2%）患者分别出现同步和异时性肿瘤。5 年和 10 年的异时性肿瘤风险分别为 9.8%和 27.2%。异时性肿瘤发生的中位时间为 103.1 个月。虽然年龄（P＜0.001）和胃黏膜萎缩（P=0.09）与同步性肿瘤的发生有关，但年龄（P=0.017）、不完全切除（P=0.025）和胃黏膜肠上皮化生（P=0.017）与多变量分析中背景黏膜的异时性肿瘤发生显著相关。在 H. pylori 阴性、根除和持续存在的组中，SMN 的累积发生率无显著差异。
胃黏膜异型增生患者的年龄、不完全 ER 及背景肠化生与异时性复发显著相关。对胃黏膜异型增生 ER 后异时性复发进行内镜监测，随访时间应超过 10 年。
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