Endoscopic Submucosal Dissection for Upgrading Diagnosis of Gastric Low Grade Intraepithelial Neoplasia After Radiofrequency Ablation - 2 Case Reports: 2622

Gastric low grade intraepithelial neoplasia is a precancerous disease, which increased the risk of gastric cancer. Endoscopic procedure which are including endoscopic submucosal dissection (EMR), endoscopic submucosal dissection (ESD), argon plasma coagulation (APC) and radiofrequency ablation (RFA). APC and RFA are better treatment to diagnosis of gastric low grade intraepithelial neoplasia. However, we found 2casesafter RFA upgrading diagnosis high grade gastric dysplasia and accepted sequential ESD. These cases report aim effect of RFA on submucosal fibrosis, which is influenced the difficulty of subsequent ESD operations. In our study, 137 patients who had diagnosed low grade gastric dysplasia in histological were performed endoscopic RFA. 115 patients were followed up by endoscopy until 1 month post-RFA, which 2 patients were diagnosed high grade gastric dysplasia at situ lesions. The 2 cases were considered upgrade of the original lesion. After communicating with the patient, it was decided ESD. During the ESD operation, to observe the condition of submucosal fibrosis, the degree of influence of submucosal fibrosis on the operation (To observe the white fiber after lesion subcutaneous injection is divided into A0 to A3, A0 degree is represents no submucosal fibrosis, and A3 degree is represents the most severe submucosal fibrosis which would not preform ESD), the operation time, the occurrence of severe complications such as intraoperative and postoperative bleeding and perforation. The 2 patients were male, which was 53 years old and 47 years old. Lesions located in the gastric antrum bending and small curvature of the body, which size were 1.5cm x 1.5cm, 2cm x 2cm and lesion macroscopic morphology were elevated type. ESD was performed at 63 and 49 days after RFA operation, and ESD was successfully performed in 2 patients. The 2patients of degree submucosal fibrosis were A0 and A1. The operation time was 48min and 52min respectively. The average dissection speed was 0.13 cm2 /min and 0.19 cm2 / min. There has no serious complications such as intraoperative and postoperative. RFA have a good effect on eradication gastric low grade intraepithelial neoplasia with less impact on the formation of gastric submucosal fibrosis, while diagnosis upgrade of gastric low grade intraepithelial neoplasia need to be performed subsequent ESD that does not cause difficulty in operation. Large sample of research will be carried out in the follow.Figure: Gastric low grade intraepithelial neoplasia after radiofrequency ablation 1m was upgrading diagnosis high grade gastric dysplasia.Figure: Sequential ESD was not influenced by submucosal fibrosis.