Related factors analysis of the pathological escalation in patients with esophageal LGIN after ESD

ObjectiveTo analyze the related factors of pathological escalation after endoscopic submucosal dissection(ESD) in patients with low-grade intraepithelial neoplasia(LGIN) of esophagus.

MethodsThe clinical data of 83 patients with esophageal LGIN diagnosed by pathology before ESD from March 2013 to March 2018 were retrospectively analyzed.The univariate and multivariate logistic regression analysis were used to analyze the related factors of pathological escalation after ESD.

ResultsAmong 83 cases with esophageal LGIN, there were 44 cases(53.01%) with pathological escalation after ESD, which included 8 cases of early esophageal squamous cell carcinoma and 36 cases of high-grade intraepithelial neoplasia(HGIN).The results of postoperative pathology showed that 35 cases(42.17%) were esophageal LGIN, and 4 cases(4.82%) were chronic esophageal inflammation.Thirty-five cases were diagnosed using narrow-band imaging magnifying endoscopy before ESD, the depth of invasion in 30 cases were accurately judged, and the accuracy rate of which was 85.71% (30/35).The results of univariate analysis showed that the incidence rate of the pathological escalation in patients with nodular changes and reddening of mucosal surface was significantly higher than that in patients without nodular changes and redness of mucosal surface(P < 0.01 and P < 0.05), but there was no statistical significance in the incidence rate of pathological escalation in patients with different gender, ages, endoscopic classification, lesion ranges, lesion location and lesion morphology(P>0.05).The results of multivariate logistic regression analysis showed that nodular changes(OR=3.86, 95%CI:1.63-9.14) and mucosal surface rednes(OR=2.95, 95%CI:1.60-5.41) were the influencing factors of pathological escalation in patients with esophageal LGIN after ESD(P < 0.01).

ConclusionsThe postoperative pathological escalation of esophageal LGIN is common, and the nodular changes and redness of mucosal surface are the risk factors of pathological escalation.In clinical practice, we should pay more attention to this kind of patients.It is of great clinical significance to improve the accuracy of preoperative pathological evaluation using narrow-band imaging magnifying endoscopy diagnosis and auxiliary pathological examination.