Published online Feb 21, 2024. doi: 10.3748/wjg.v30.i7.673
Peer-review started: December 11, 2023
First decision: December 19, 2023
Revised: December 25, 2023
Accepted: January 22, 2024
Article in press: January 22, 2024
Published online: February 21, 2024
Gastric cystica profunda (GCP) is an uncommon gastric lesion characterized by hyperplasia of connective tissues within the interstitium of the glands, involving the submucosal layer or even the muscularis propria of the stomach. Widespread chronic active or atrophic gastritis is considered a significant factor contributing to GCP. Patients with GCP may either be asymptomatic or present with non-specific digestive symptoms such as abdominal pain and belching. Due to the indistinct clinical characteristics and non-specific endoscopic manifestations, most clinicians have limited understanding of GCP. Additionally, GCP has been regarded as a potential premalignant lesion. Endoscopic identification of irregular shapes and mucosal lesion types may serve as high-risk factors for GCP associated with early gastric cancer (EGC). Irrespective of EGC presence, endoscopic submucosal dissection emerges as a secure and effective minimally invasive treatment.
Patients with GCP may either remain asymptomatic or present with non-specific digestive symptoms, including abdominal pain and belching. Owing to the unremarkable clinical characteristics and nonspecific endoscopic manifestations, most clinicians possess limited understanding of GCP. Furthermore, GCP has been regarded as a potential premalignant lesion; hence, the endoscopic diagnosis and early excision of GCP are deemed crucial. In this study, we conducted a retrospective analysis of 104 cases of GCP treated by endoscopic resection at our center from October 2011 to December 2022. Our analysis was based on their clinical manifestations, endoscopic findings, pathological results, and treatments. The primary objectives were to delineate the endoscopic features of GCP associated with EGC and to assess the impact of endoscopic resection on the diagnosis and treatment of GCP with EGC.
Given the limited literature and reports on GCP, our research might hold significance in raising awareness of GCP as a high-risk factor for EGC. Clinical differentiation from conditions such as hypertrophic gastritis, mesenchymal tumors, gastric cancer, and ectopic pancreas is crucial. Due to GCP's malignant potential, prompt removal through endoscopy or surgery is essential, coupled with regular postoperative follow-up. In this study, we delineated the endoscopic features of GCP and evaluated the impact of endoscopic resection on the diagnosis and treatment of GCP.
This retrospective study involved 104 patients with GCP who underwent endoscopic resection. Alongside demographic and clinical data, regular patient follow-ups were conducted to assess local recurrence.
Among the 104 patients diagnosed with GCP who underwent endoscopic resection, 12.5% had a history of previous gastric procedures. The primary site predominantly affected was the cardia (38.5%, n = 40). GCP commonly exhibited intraluminal growth (99%), regular presentation (74.0%), and ulcerative mucosa (61.5%). The leading endoscopic feature was the mucosal lesion type (59.6%, n = 62). The average maximum diameter was 20.9 ± 15.3 mm, with mucosal involvement in 60.6% (n = 63). Procedures lasted 73.9 ± 57.5 min, achieving complete resection in 91.3% (n = 95). Recurrence (4.8%) was managed via either surgical intervention (n = 1) or through endoscopic resection (n = 4). Final pathology confirmed that 59.6% of GCP cases were associated with EGC. Univariate analysis indicated that elderly males were more susceptible to GCP associated with EGC. Conversely, multivariate analysis identified lesion morphology and endoscopic features as significant risk factors. Survival analysis demonstrated no statistically significant difference in recurrence between GCP with and without EGC (P = 0.72).
The findings suggested that endoscopic resection might serve as an effective and minimally invasive treatment for GCP with or without EGC.
Further research is imperative to gain a more comprehensive understanding of the natural progression of GCP and its malignant potential.