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Published on: February 16, 2024
Autoimmune gastritis potentiates polypoid nodule scar formation after endoscopic resection: implications for
Shiyun Mai1, Xiaochu Zhao1, Xiaoting Feng1
1Department of Endoscopy, The First Affiliated Hospital of China Medical University, Shenyang, China.
Background:
Endoscopic resection has become a cornerstone treatment for gastric mucosal lesions, yet polypoid nodule scar (PNS) formation emerges as a significant post-procedural sequela. Given the chronic inflammatory environment and hypergastrinemia characteristic of autoimmune gastritis (AIG), this study investigates the association between AIG and PNS development following endoscopic resection of the gastric antrum, aiming to optimize postoperative surveillance strategies for high-risk populations prone to PNS.
Methods:
This retrospective cohort study analyzed 109 patients undergoing R0 resection of gastric antral lesions via ESD/EMR at The First Affiliated Hospital of China Medical University (January 2021-December 2024). Inclusion criteria required complete en bloc resection and endoscopic follow-up.
Results:
Postoperative PNS developed in 23 cases (21.1%, 95% CI: 13.32%-28.88%). Univariate analysis identified female sex (p < 0.001), age < 62 years (p = 0.028), baseline inflammatory lesions (p < 0.001), AIG (p < 0.001) as significant predictors. Multivariate Firth regression confirmed baseline inflammatory lesions (OR = 10.96, 95% CI: 1.61-85.81, p = 0.015) and AIG (OR = 83.22, 95% CI: 11.55-1397.93, p < 0.001) as independent risk factors. Analysis of available data showed serum gastrin-17 levels were significantly higher in PNS patients than in controls (p < 0.001) and exhibited strong predictive value for PNS (AUC = 0.913, p < 0.001), identifying it as a potential biomarker despite a limited sample size.
Conclusions:
This pioneering study establishes AIG as a critical risk factor for PNS development post-ESD/EMR. Key implications include: (i) Mandatory preoperative risk counseling for AIG patients; (ii) Implementation of enhanced surveillance protocols combining biannual endoscopy and gastrin monitoring for high-risk cohorts; (iii) Conservative management with endoscopic monitoring for established PNS. These findings underscore the necessity of personalized postoperative care pathways based on autoimmune status.
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