title: [Clinical value of the narrow-band imaging combined with endoscopic submucosal dissection for gastric high grade intraepithelial neoplasia].
abstract: OBJECTIVE
  To determine the feasibility, safety and short-time efficacy of narrow-band imaging (NBI) combined with endoscopic submucosal dissection (ESD) for treating gastric high grade intraepithelial neoplasia (HGIN).
  
  
  METHODS
  Clinical data of 78 patients with gastric HGIN diagnosed by gastroscope and pathology undergoing NBI combined with ESD at Wuxi No.2 People's Hospital and Zhongshan Hospital of Fudan University from January 2014 to December 2015 were retrospectively analyzed. Their clinicopathological and follow-up data were analyzed.
  
  
  RESULTS
  There were 47 males and 31 females aged from 38 to 85 years old. Preoperative NBI showed that lesions of all the 78(100%) patients had clear resection margin, and 91%(71/78) lesions had abundant vessels in the central depression area. One case was converted to open abdominal operation due to intra-operational perforation, 77(98.7%) gastric HGIN lesions were successfully dissected under ESD, including 74 cases(94.9%) of en bloc dissection, and other 3 cases with severe adhesion of submucosa whose lesion wound after ESD was treated with argon plasma coagulation(APC). The mean maximum diameter of the lesion size was (1.2±0.8) cm. The average operation time was(48±21) minutes. Delayed hemorrhage occurred in 5 cases(6.4%) who were also treated successfully by endoscopic hemostasis. Postoperational pathology revealed en bloc dissection rate was 91.0%(71/78), positive rate of resection margin was 3.8%(3/78), and healing dissection rate was 89.7%(70/78). Thirty-two lesions (41.0%) remained the diagnosis as HGIN, 6 lesions(7.7%) were diagnosed as low grade intraepithelial neoplasia, and 40 lesions (51.3%) were diagnosed as adenocarcinoma. Fifty-seven cases were followed up for 12 months, 21 cases were followed up for 6 months, and there was no recurrence in those 3 patients with positive margin. Two cases (2.6%) relapsed and were diagnosed as adenocarcinoma by repeat pathology examination.
  
  
  CONCLUSIONS
  NBI combined with ESD for diagnosis and treatment of gastric HGIN is safe and effective, and can achieve en bloc complete resection of the lesions with a low complication rate.
authors.affiliation: Endoscopy Center, Wuxi NO.2 People's Hospital, Jiangsu Wuxi 214002, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Endoscopy Center, Wuxi NO.2 People's Hospital, Jiangsu Wuxi 214002, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Gong
authors.affiliation: Endoscopy Center, Wuxi NO.2 People's Hospital, Jiangsu Wuxi 214002, China.
authors.forename: Xuejun
authors.initials: X
authors.lastname: Tang
authors.affiliation: Endoscopy Center, Wuxi NO.2 People's Hospital, Jiangsu Wuxi 214002, China.
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Wang
authors.affiliation: Endoscopy Center, Wuxi NO.2 People's Hospital, Jiangsu Wuxi 214002, China.
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Peng
authors.affiliation: Endoscopy Center, Wuxi NO.2 People's Hospital, Jiangsu Wuxi 214002, China.
authors.forename: Gaoju
authors.initials: G
authors.lastname: Wu
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China. yao.liqing@zs-hospital.sh.cn.
authors.forename: Liqing
authors.initials: L
authors.lastname: Yao
authors.affiliation: Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Shi
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000601:surgery*; D004210:Dissection; D004724:Endoscopy; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*