Factors Associated With Advanced Histological Diagnosis and Upstaging After Endoscopic Submucosal Dissection of Superficial Gastric Neoplasia

Background and Aims: Endoscopic submucosal dissection (ESD) is an important treatment for gastric neoplasia. Some gastric adenomas with low-grade dysplasia (LGD) and high-grade dysplasia (HGD) on endoscopic forceps biopsy (EFB) are diagnosed as gastric adenocarcinoma (GAC) after ESD. We aimed to identify factors associated with histological diagnosis of gastric lesions and predictors for pathological upstaging following ESD. Methods: This retrospective study analyzed data from 309 patients who underwent gastric ESD at 25 tertiary care centers in North America. Variables assessed included demographic characteristics, endoscopic lesion characteristics, and histopathological diagnoses. We used logistic regression to identify predictors of GAC following ESD, as well as pathologic upstaging from EFB to ESD. Results: Four point one percent of all cases with LGD and 12.8% with HGD on EFB were upstaged to GAC after ESD. There were no significant predictors of pathologic upstaging. However, logistic regression revealed that age (odds ratio [OR] = 1.05, P < 0.01), the presence of ulceration (OR = 2.76, P < 0.01), and tumors located in the upper third (OR = 2.35, P = 0.01) or lower third of the stomach (OR = 1.92, P = 0.02) significantly predicted GAC. Conclusion: In this large North American cohort of patients treated with gastric ESD, we found that tumor location in the upper and lower thirds of the stomach, tumor ulceration, and patient age could predict GAC. Endoscopists should be cognizant of these characteristics as up to 16.9% of lesions may be upstaged to GAC.