Role of submucosal injection in radiofrequency ablation of gastric low-grade dysplasia: Effects on symptoms and outcomes

Xiaotong Niu; Nanjun Wang; Yan Wang; Jia Feng; Longsong Li; Ke Han; Ningli Chai; Enqiang Linghu

doi:10.1097/CM9.0000000000003080

Role of submucosal injection in radiofrequency ablation of gastric low-grade dysplasia: Effects on symptoms and outcomes

Chin Med J (Engl). 2024 Apr 10. doi: 10.1097/CM9.0000000000003080. Online ahead of print.

Authors

Xiaotong Niu^{1

2}, Nanjun Wang², Yan Wang^{2

3}, Jia Feng⁴, Longsong Li², Ke Han^{1

2}, Ningli Chai², Enqiang Linghu²

Affiliations

¹ Medical School of Chinese PLA General Hospital, Beijing 100853, China.
² Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
³ Nankai University School of Medicine, Nankai University, Tianjin 300071, China.
⁴ Department of Gastroenterology, Bethune International Peace Hospital, ShijiaZhuang, Hebei 050082, China.

PMID: 38602084
DOI: 10.1097/CM9.0000000000003080

Abstract

Background: To date, there is still a lack of standardized management strategies for gastric low-grade dysplasia (LGD), which is a direct neoplastic precancerous lesion and requires specifically superficial destruction. Radiofrequency ablation (RFA) is expected to be an effective method for gastric LGD, but post-RFA pain may affect patients' satisfaction and compliance. The current study aimed to evaluate the value of a submucosal injection prior to RFA (SI-RFA) for postoperative pain and treatment outcomes.

Methods: Between October 2014 and July 2021, gastric LGDs without risk factors (size >2 cm, unclear boundary, and abnormal microsurface and microvascularity) undergoing regular RFA and SI-RFA were retrospectively analyzed. Postoperative pain scores, wound healing, and clinical efficacy were compared. Propensity score matching, stratified analysis, and multivariable logistic regression were performed to control the confounding variables.

Results: One hundred and ninety-seven gastric LGDs in 151 patients received regular RFA. Forty-nine gastric LGDs in 36 patients received SI-RFA. Thirty-six pairs of patients were selected for the assessment of postoperative pain by propensity score matching. Compared to regular RFA, SI-RFA significantly decreased the degree and duration of postoperative pain (OR, 0.32; 95% CI, 0.13-0.84; P = 0.020), improved wound healing rate (80.0% [36/45] vs. 58.9% [89/151], P = 0.012), increased the complete ablation rate (91.8% [45/49] vs. 86.3% [170/197], χ2 = 1.094, P = 0.295), but correlated with higher rates of local recurrence and progression (25.6% [10/39] vs. 13.2% [18/136], χ2 = 3.471, P = 0.062; 8.3% [3/36] vs. 0.9% [1/116], P = 0.042). The multivariable logistic regression model confirmed that submucosal injection was associated with local recurrence (OR, 2.93; 95% CI, 1.13-7.58; P = 0.027).

Conclusions: Submucosal injections prior to RFA may reduce postoperative pain and scar formation while ensuring complete ablation of gastric LGD. However, local recurrence and progression should be considered seriously.