Clinicopathological Characteristics of Gastric Adenocarcinoma of Fundic Gland Type and Feasibility of Endoscopic Submucosal Dissection

ZHU Xiaolei; LI Kai; TANG Xiaojing

doi:10.3969/j.issn.1004-437X.2026.03.020

Abstract：Objective To investigate the clinicopathological characteristics of patients with gastric adenocarcinoma of fundic gland type(GA-FG)and the feasibility of endoscopic submucosal dissection(ESD).Methods The clinical data of 68 patients with GA-FG in Shangqiu Traditional Chinese Medicine Hospital from January 2020 to March 2023 were retrospectively analyzed.The clinicopathological characteristics of GA-FG were analyzed.According to surgical methods,they were divided into ESD group(41 cases)and endoscopic mucosal resection(EMR)group(27 cases).The therapeutic efficacy and postoperative complications of the two groups were compared.The prognosis of the patients was observed after 1 year of follow-up,and the clinical feasibility of ESD in the treatment of GA-FG was evaluated.Results Among 68 patients with GA-FG,22 cases(32.36％)were complicated with Helicobacter pylori infection.Among the main clinical manifestations,patients without discomfort accounted for the largest proportion(42.64％),followed by acid reflux(35.29％)and abdominal distension(23.52％).The lesions of 68 patients with GA-FG under white light endoscopy were mostly distributed in the gastric fundus(44.12％)and the upper 1/3 of the gastric body(25.00％),and the color of the lesions was similar to the surrounding mucosa(42.64％)or faded(44.12％),Paris classification was mostly 0-Ⅱa type(57.35％)and 0-Ⅱb type(30.88％).Under magnifying endoscopy,the microstructure of gastric fundus gland was irregular,and the microvessels were distorted and proliferated,mostly branched.Histopathological examination showed that all the 68 patients with GA-FG were dominated by principal cells,with fovea epithelium on the surface of the lesion and infiltrating into the mucous membrane and submucosa.Ki-67 expression was mainly negative(30.88％)or 5％(51.47％),and MUC6 expression accounted for 79.41％.The surgical time in ESD group was longer than that in EMR group(P＜0.05).No perforation and secondary surgery occurred in both groups.There were no statistical differences in hospital stay,positive margin rate and incidence rate of delayed bleeding between the two groups(P＞0.05).The two groups survived at 1 year after surgery,and there was no recurrence or metastasis.Conclusion GA-FG is usually asymptomatic,and a variety of pathological characteristics can be observed under endoscopy and histopathology.ESD is effective in the treatment of GA-FG and can effectively control the lesions.