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Treatment of Gastric Epithelial Dysplasia That Is Diagnosed by Endoscopic Biopsy  

Kim, Eun-Young (Department of Surgery, Incheon St. Mary's Hospital The Catholic University of Korea, School of Medicine)
Kim, Jin-Jo (Department of Surgery, Incheon St. Mary's Hospital The Catholic University of Korea, School of Medicine)
Kim, Byung-Wuk (Department of Gastroenterology, Incheon St. Mary's Hospital The Catholic University of Korea, School of Medicine)
Park, Seung-Man (Department of Surgery, Incheon St. Mary's Hospital The Catholic University of Korea, School of Medicine)
Publication Information
Journal of Gastric Cancer / v.10, no.1, 2010 , pp. 1-4 More about this Journal
Abstract
Purpose: Gastric epithelial dysplasia (GED) was defined as "unequivocally neoplastic epithelium that may be associated with or give rise to invasive adenocarcinoma" and GED also represents a direct precursor of intestinal type adenocarcinoma of the stomach. The recommended treatment guidelines for GED in the medical literature are endoscopic mucosal resection (EMR) or surgery for high grade dysplasia (HGD) and annual endoscopic surveillance with biopsy for low grade dysplasia (LGD) The aim of this study was to determine the treatment plan for GED that is diagnosed by endoscopic biopsy. Materials and Methods: We enrolled 148 patients who were treated by endoscopic mucosal resection (EMR) or endoscopiccsubmucosal dissection (ESD) for GED: there were 63 patients with HGD and 85 patients with LGD and all of them were diagnosed by endoscopic biopsy from January 2006 to December 2008. The results of the final histopathologic reports after EMR or ESD were compared with the results of the endoscopic biopsies. Results: The final histopathologic results of the 148 patients with GED showed 49 (33.1%) patients with adenocarcinoma, 40 (27.0%) patients with HGD and 59 (39.9%) patients with LGD. Among the 63 patients with HGD, 34 (54.0%) patients had adenocarcinoma, 20 (31.7%) patients had HGD and 9 (14.3%) patients had LGD. For the 85 patients with LGD, 15 (17.6%) patients had adenocarcinoma, 20 (23.5%) patients had HGD and 50 (58.8%) patients had LGD Conclusion: Complete resection, including EMR or ESD, is needed for patients with GED diagnosed by endoscopic biopsy and they have HGD. For patients with LGD, EMR or ESD may be needed in addition to endoscopic surveillance with biopsy for making the correct diagnosis and proper treatment because of the possibility of adenocarcinoma.
Keywords
Gastric epithelial dysplasia; Gastric adenocarcinoma; Endoscopic mucosal resection; Endoscopic submucosal dissection;
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1 Bajtai A, Hidvegi J. The role of gastric mucosal dysplasia in the development of gastric carcinoma. Pathol Oncol Res 1998;4:297-300.   DOI   ScienceOn
2 Rugge M, Cassaro M, Di Mario F, Leo G, Leandro G, Russo VM, Pennelli G, Farinati F; Interdisciplinary Group on Gastric Epithelial Dysplasia (IGGED). The long term outcome of gastric non-invasive neoplasia. Gut 2003;52:1111-1116.   DOI   ScienceOn
3 Di Gregorio C, Morandi P, Fante R, De Gaetani C. Gastric dysplasia. A follow-up study. Am J Gastroenterol 1993;88: 1714-1719.
4 Lauwers GY, Srivastava A. Gastric preneoplastic lesion and epithelial dysplasia. Gastroenterol Clin N Am 2007;36:813- 829.   DOI   ScienceOn
5 Kim H, Jin SY, Jang JJ, Kim WH, Song SY, Kim KR, Yu ES, Shin HS, Kim HK, Sohn JH, et al. Grading system for gastric epithelial proliferative diseases standardized guidelines proposed by Korean study group for pathology of digestive diseases. Korean J Pathol 1997;31:389-400.
6 Goldstein NS, Lewin KJ. Gastric epithelial dysplasia and adenoma: historical review and histological criteria for grading. Hum Pathol 1997;28:127-133.   DOI   ScienceOn
7 Schemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, Dixon MF, Fengolio-Preiser CM, Flejou JF, Geboas K, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000;47:251-255.   DOI   ScienceOn
8 Zhang Y. Typing and grading of gastric dysplasia. In: Zhang Y, Kawai K, eds. Precancerous Conditions and Lesions of the Stomach. Berlin: Springer-Verlag, 1993:64-84.
9 Ming SC, Bajtai A, Correa P, Elster K, Jarvi OH, Munos N, Nakayo K, Stemmerman GN. Gastric dysplasia: significance and pathologic criteria. Cancer 1984;54:1794-1801.   DOI   ScienceOn
10 Correa P. A human model of gastric carcinogenesis. Cancer Res 1988;48:3554-3560.
11 Kim YD, Cho JY, Jung IS, Koh BM, Hong SJ, Ryu CB, Kim JO, Lee JS, Lee MS, Jin SY, et. al. Comparison of endoscopic forcep biopsy and the histopathologic diagnosis after endoscopic submucosal dissection. Korean J Gastrointest Endosc 2009;38:188-192.
12 Takahashi H, Fujisaki J, Kamiyama T, Ishiyama A, Yamamoto Y, Hosaka N, Fujita R, Kato H, Muto T. Treatment strategy for gastric adenoma based in cases with long-term follow-up and endoscopic resection-from the point of active resection. Stomach and Intestine 2003;38:1411-1418.
13 Hwang JY, Park KS, Hwang JS, Ahn JS, Park SK. Histological comparison of endoscopic forceps biopsy with endoscopic resection in gastric mucosal elevated lesion. Korean J Gastrointest Endosc 2003;26:68-72.
14 Hasuike N, Oda I, Gotoda T, Hamanaka H, Yamaguchi H, Kozu T, Matsuda N, Saito D, Shimoda T. Clinical management of gastric adenoma, from the point of view of endoscopic surveillance. Stomach and Intestine 2003;38:1419-1426.
15 Hansson LE, Lindgren A, Nyren A. Can endoscopic biopsy specimens be used for reliable Laurén classification of gastric cancer? Scand J Gastroenterol 1996;31:711-715.   DOI   ScienceOn
16 Namieno T, Koito K, Higashi T, Shimamura T, Yamashita K, Sato N, Kondo Y. Assessing the suitability of gastric carcinoma for limited resection: histologic differentiation of endoscopic biopsy. World J Surg 1998;22:865-868.   DOI   ScienceOn
17 Park HK, Cheon YK, Jung HK, Park HJ, Cho JY, Cheon GJ, Jung IS, Kim JO, Lee JS, Jin SY, et. al. The study of pathologic difference between endoscopic biopsy before EMR and histology of specimen after endoscopic mucosal resection (EMR) on gastric flat adenoma or early gastric cancer (EGC). Korean J Gastrointest Endosc 2001;23:431-436.
18 Shon JH, Bae HK, Cho KB, Kwon DY, Park KS, Hwang JS, Huh JW, Ahn SH, Park SK. Histological comparison of endoscopic biopsy with endoscopic eesection in gastric adenoma. Korean J Gastrointest Endosc 2001;23:363.
19 Oehlert W, Keller P, Henke M, Strauch M. Gastric mucosal dysplasia: what is its clinical significance? Front Gastrointest Res 1979;4:173-182.