Jiang Wei, Bai Liyi, Zhang Shutian, Cheng Rui
Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, 100050, PR China.
Heliyon. 2024 Apr 6;10(7):e29349. doi: 10.1016/j.heliyon.2024.e29349. eCollection 2024 Apr 15.
Cystic dilatation of the gastric glands within the mucosal layer is the hallmark of the rare condition known as gastritis cystica profunda (GCP). Although it has been proved that GCP is the precursor lesion for early gastric cancer (EGC), the management strategy of GCP-related EGC is not well established.The purpose of this research was to determine if ESD is effective and safe for GCP-related EGC.
Patients with EGC who had ESD at Beijing Friendship Hospital between January 2015 and May 2023 were retrospectively included. All patients were divided into two groups: those with GCP-related EGC, and those with EGC alone. The two groups were matched 1:1 using the propensity score matching (PSM) method. Curative resection rate, postoperative adverse outcome rate (bleeding, perforation, stricture), and recurrence rate were the primary measures used to evaluate the efficacy and safety of ESD.
There were a total of 386 participants (44 with GCP and 342 with EGC alone). Following PSM, 44 patients were paired and analyzed separately. Except for the presence of cysts in EUS (multiple/single/none cyst: 12/2/5 versus 1/0/25, P < 0.0001), there was no change in baseline characteristics, EUS appearance, or histology results between groups. Overall, there was no significant difference in curative resection rates between the GCP group (70.5 %) and the control group (81.8 %) (P = 0.211). Postoperative complications were comparative (9/44 vs 5/44, P = 0.244), as were rates of local recurrence (1/44 vs 0/44, P = 1.0), metachronous gastric cancer (1/44 vs 0/44, P = 1.0), and mortality (0/44 vs 0/44, P = 1.0).
Existence of cysts in EUS is a characteristic presentation to distinguish GCP-related EGC from EGC-alone lesions. ESD might be a safe and effective therapy for patients with GCP-related EGC.
黏膜层内胃腺的囊性扩张是一种罕见疾病——深部囊性胃炎（GCP）的标志。尽管已证实GCP是早期胃癌（EGC）的前驱病变，但GCP相关EGC的治疗策略尚未完全确立。本研究的目的是确定内镜黏膜下剥离术（ESD）对GCP相关EGC是否有效且安全。
回顾性纳入2015年1月至2023年5月在北京友谊医院接受ESD治疗的EGC患者。所有患者分为两组：GCP相关EGC患者和单纯EGC患者。采用倾向评分匹配（PSM）方法将两组患者1:1匹配。根治性切除率、术后不良结局发生率（出血、穿孔、狭窄）和复发率是评估ESD疗效和安全性的主要指标。
共有386名参与者（44例GCP患者和342例单纯EGC患者）。PSM后，44例患者配对并分别进行分析。除超声内镜（EUS）检查中囊肿的存在情况（多发/单发/无囊肿：12/2/5 vs 1/0/25，P < 0.0001）外，两组间基线特征、EUS表现或组织学结果无变化。总体而言，GCP组（70.5%）和对照组（81.8%）的根治性切除率无显著差异（P = 0.211）。术后并发症情况相近（9/44 vs 5/44，P = 0.244），局部复发率（1/44 vs 0/44，P = 1.0）、异时性胃癌发生率（1/44 vs 0/44，P = 1.0）和死亡率（0/44 vs 0/44，P = 1.0）也相近。
EUS检查中囊肿的存在是区分GCP相关EGC与单纯EGC病变的特征性表现。ESD可能是治疗GCP相关EGC患者的一种安全有效的方法。
