title: Is lesion size an independent indication for endoscopic resection of biopsy-proven low-grade gastric dysplasia?
abstract: OBJECTIVE
  The standard treatment for patients with gastric low-grade dysplasia (LGD) remains controversial, even though diagnosis of LGD is increasingly common as esophagogastrodeuodenoscopy becomes more available. The aim of this study was to identify a lesion size cut-off as an indication for endoscopic resection (ER) for patients with LGD.
  
  
  RESULTS
  We retrospectively reviewed 285 lesions initially diagnosed as LGD by endoscopic forceps biopsies (EFB) from 2007 to 2010 in Kyung Hee University Hospital, Seoul, Korea. All patients underwent ER. A total of 285 lesions from 257 patients were assessed. After ER, 239 LGD (83.9 %) showed histological concordance and the remaining 46 (16.1 %) cases revealed an upgraded histology [22 high-grade dysplasia (7.7 %), and 24 differentiated adenocarcinoma (8.4 %)]. Univariate analyses demonstrated that lesion size, erythema, depression, and erosion were significant predictors of upgraded LGD (P < 0.001). Multivariate analysis showed that a lesion size ≥2 cm, erythema, and a depressed-type lesion were independent predictors of upgraded histology (P = 0.014, odds ratio 3.27, 95 % confidence interval 1.28-8.39).
  
  
  CONCLUSIONS
  Our data suggest that a substantial number of LGD diagnoses based on EFB were not representative of the entire lesion. We recommend ER if gastric LGD has at least one of the following risk factors: surface erythema and a depressed type regardless of size, or ≥2 cm size regardless of abnormal surface configuration.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Hoegi-dong 1, Dongdaemoon-gu, Seoul, 130-702, South Korea.
authors.forename: Min Kyung
authors.initials: MK
authors.lastname: Kim
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Jang
authors.forename: Jung-Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Jae-Jun
authors.initials: JJ
authors.lastname: Shim
authors.forename: Chang Kyun
authors.initials: CK
authors.lastname: Lee
authors.forename: Young Woon
authors.initials: YW
authors.lastname: Chang
authors.forename: Bong Keun
authors.initials: BK
authors.lastname: Choe
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D003951:Diagnostic Errors; D004210:Dissection / Q000379:methods*; D005260:Female; D005773:Gastroscopy; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D016017:Odds Ratio; D011237:Predictive Value of Tests; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden
references.citation: Clin Gastroenterol Hepatol. 2007 Feb;5(2):160-5
references.pmid: 17296525
references.citation: Gut Liver. 2012 Oct;6(4):446-51
references.pmid: 23170148
references.citation: Gastrointest Endosc. 1991 May-Jun;37(3):332-7
references.pmid: 2070985
references.citation: Eur J Gastroenterol Hepatol. 2008 Oct;20(10):966-70
references.pmid: 18787462
references.citation: Gut. 2003 Aug;52(8):1111-6
references.pmid: 12865267