How Commonly Is the Diagnosis of Gastric Low Grade Dysplasia Upgraded Following Endoscopic Resection? A Meta-Analysis

PLoS One. 2015 Jul 16;10(7):e0132699. doi: 10.1371/journal.pone.0132699. eCollection 2015.


Gastric dysplasia is a well-known precancerous lesion. Though the diagnosis of gastric low grade dysplasia (LGD) is generally made from endoscopic forceps biopsy (EFB), the accuracy is doubtful after numerous EFB-proven gastric LGD were upgraded to gastric high grade dysplasia (HGD) or even carcinoma (CA) by further diagnostic test with the procedure of endoscopic resection (ER). We aimed to evaluate the upgraded diagnosis rate (UDR) and the risk factors by ER in EFB-proven gastric LGD lesions. Two investigators independently searched studies reporting the UDR by ER in EFB-proven gastric LGD lesions from databases and analyzed the overall UDR, HGD-UDR and CA-UDR. The pooled UDR by ER in EFB-proven gastric LGD lesions was 25.0% (95% CI, 20.2%-29.8%), made up of HGD-UDR and CA-UDR by rates of 16.7% (95% CI, 12.8%-20.6%) and 6.9% (95% CI, 4.2%-9.6%) respectively. Lesion size larger than 2 cm, surface with depression and nodularity under endoscopic examinations were the major risk factors associated with UDR. In conclusion, one quarter of EFB-proven gastric LGD lesions will be diagnosed as advanced lesions, including gastric HGD (16.7%) and gastric CA (6.9%) by ER. The diagnosis of those LGD lesions with an endoscopic diameter larger than 2cm, and depressed or nodular surface are more likely to be upgraded after ER.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / diagnosis*
  • Adenoma / pathology
  • Adenoma / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Female
  • Gastric Mucosa / pathology*
  • Gastric Mucosa / surgery
  • Gastroscopy
  • Humans
  • Male
  • Middle Aged
  • Precancerous Conditions / diagnosis*
  • Precancerous Conditions / pathology
  • Precancerous Conditions / surgery
  • Risk Factors
  • Stomach / pathology*
  • Stomach / surgery
  • Stomach Neoplasms / diagnosis*
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery

Grant support

National Natural Science Foundation of China (81472214, 81302070, 81272678) (; National Basic Research Program of China (973 Program), (2012CB945004) (; Science and technology innovation team of Zhejiang Province (2013TD13) ( The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.