[Risk Factors for Missed Diagnosis of Esophageal Low-grade Intraepithelial Neoplasia in Endoscopic Forceps Biopsy Compared with Endoscopic Submucosal Dissection].

OBJECTIVE: To investigate the risk factors for pathological upgrading after endoscopic treatment of esophageal lesions which confirmed to be low-grade intraepithelial neoplasia (LGIN) by preoperative biopsy. METHODS: A total of 148 patients who were confirmed to be LGIN in preoperative forceps underwent further endoscopic resection between November 2013 and July 2018. According to the final pathological results after endoscopic treatment, they were divided into pathological upgrading group and pathological non-upgrading group, and their clinicopathological characteristics were analyzed and compared through univariate and multivariate analysis. RESULTS: The average age of the patients was (59.95±7.75) years old and the percent of male patients was 67.57% (100/148). Most lesions were located in the middle esophagus (99 cases) and lower esophagus (38 cases). Endoscopic gross type was mainly depressed type (72 cases). The en-bloc resection rate was 99.32% (147/148). Among the patients (77, 52.03%) who had pathological upgrading, 33 (22.3%) cases were HGIN, 25 (16.9%) cases were in-situ cancer, and 19 (12.8%) cases were superficial esophageal squamous cell carcinoma. Univariate analysis showed that circumferential extent (≥1/2), longitudinal diameter (≥3 cm), submucosa involvement found by endoscopic ultrasongraphy, depressed gross type and redness of lesion mucosa were risk factors for postoperative pathological upgrading. Multivariate analysis indicated that the redness of the lesion mucosa and longitudinal diameter (≥3 cm) of the lesion were independent risk factors for pathological upgrading. CONCLUSIONS: For esophageal lesions diagnosed by biopsy as LGIN, clinicians should be highly alert to the pathological underestimate if the lesion surface is reddened and its longitudinal diameter is greater than 3 cm.

[Endoscopic Characteristics and Pathological Analysis of Esophageal Low-grade Intraepithelial Neoplasm].

OBJECTIVE: To explore endoscopic characteristics and pathological changes of esophageal low-grade intraepithelial neoplasm (LGIN) as well as its risk factors. METHODS: A total of 201 LGIN lesions from 169 cases were included from January 2009 to August 2017. The endoscopic characteristics and pathological changes were analysis. Logistic regression analysis was used to analyze the risk factors of LGIN. The endoscopic morphologic findings of esophageal mucosa lesions and the pathological findings of simple inflammatory lesions were enrolled as controls. RESULTS: LGIN occurred more common in elderly patients, the ratio of male to female was 2.5∶1. The maximum transverse and the maximum longitudinal diameter (MLD) were (0.9±0.8) cm,(1.4±1.3) cm, respectively. The most common location of lesion was in the middle segment of esophagus (52.2%). The morphological types of lesions were dominantly 0-Ⅱb (45.8%) and 0-Ⅱa (31.8%). There were 42 LGIN lesions with reflux esophagitis. Multiple dysplastic lesions accounted for 57.4%. After (10.3±12.1) months follow-up, 58.2% lesions were pathological reversal with 24.9% (50/201) of the lesion completely disappeared, and 28.9% lesions had no pathological changes, but 12.9% (26/201) lesions progressed to high-grade intraepithelial neoplasia and invasive cancer. Multivariate analysis indicated that age (compared to <45 years old) and longitudinal diameter of the lesion (compared to ≤0.5 cm) were independent risk factors for LGIN. The risk of esophageal LGIN in lesions with MLD > 0.5-1 cm was 1.96 times higher than that in lesions with MLD ≤ 0.5 cm. CONCLUSIONS: The MLD of esophageal mucosal lesions >0.5 cm and age >45 years old may increase the possibility of esophageal LGIN. Close follow-up is required for LGIN lesions with MLD>1 cm.