Gastric epithelial dysplasia: characteristics and long-term follow-up results after endoscopic resection according to morphological categorization

Abstract

Background: Gastric epithelial dysplasia (GED) can be morphologically categorized into adenomatous and foveolar types. To date, there have been few studies on the clinical characteristics of GEDs according to the morphologic types. Therefore, we here aimed to elucidate the clinicopathologic characteristics of patients with GED and the long-term follow-up results after endoscopic resection according to the morphologic characteristics of GEDs.

Methods: A total of 357 patients who underwent endoscopic resection for GEDs at Pusan National University Hospital between January 2008 and December 2009 were included in the study. GEDs were morphologically categorized into adenomatous, foveolar, and hybrid types on histologic examination. The clinicopathologic characteristics of patients with GEDs and outcomes of endoscopic resection were analyzed.

Results: Patients with GED were divided into 3 groups: adenomatous (n = 167, 46.8%), foveolar (n = 103, 28.9%), and hybrid (n = 87, 24.3%) types. Compared to the adenomatous type, foveolar type lesions were more frequently located in the antrum/pylorus, flat/depressed lesions, and normal/reddish in color; and showed more frequent high-grade dysplasia. During the follow-up period (median, 37.3 months), the overall incidence of synchronous and metachronous lesions was 20.8% and 20.1%, respectively; of these, the incidence of synchronous and metachronous gastric cancer was 8.7% and 5.4%, respectively. There were no significant differences in the incidence of synchronous and metachronous lesions according to morphologic types.

Conclusion: GEDs appear to have different clinicopathologic characteristics according to morphologic types. Irrespective of the morphology, synchronous and metachronous gastric cancers are commonly found after endoscopic resection of GEDs. Therefore, close follow-up surveillance after endoscopic resection of GEDs should be performed for all patients.

Figure 1

Flow chart of the patient inclusion in the study. GED, gastric epithelial dysplasia.

Figure 2

Representative endoscopic and histologic findings of an adenomatous-type gastric epithelial dysplasia. (A) An elevated lesion with nodular changes is seen at the lesser curvature of the lower body. (B) On histology, tubules lined by columnar cells with hyperchromatic, pencillate nuclei with pseudostratification, and little branching or irregularity are noted (hematoxylin and eosin stain, ×200).

Figure 3

Representative endoscopic and histologic findings of a foveolar-type gastric epithelial dysplasia. (A) A slightly depressed lesion is seen at the lesser curvature of the antrum. (B) On histology, cuboidal to columnar cells with pale cytoplasm and basally located ovoid nuclei with branching, budding and a cribriform pattern are observed (hematoxylin and eosin stain, ×200).

Figure 4

Representative endoscopic and histologic findings of a hybrid-type gastric epithelial dysplasia. (A) A nodular lesion with slight central depression is seen at the anterior wall of the antrum. (B) On histology, features of both foveolar-type and adenomatous-type dysplasias are observed (hematoxylin and eosin stain, ×200).