To investigate the risk factors for neoplasia in pale lesions of gastric mucosa, and provide clinical clues for early diagnosis.

A total of 402 patients with gastric mucosal pale lesions who underwent gastroscopy at The Seventh Medical Center of Chinese PLA General Hospital from January 2020 to May 2021 were enrolled in the retrospective analysis. Data of gender and age of patients, degree of gastric mucosal atrophy, lesion boundaries, size, location, morphology, narrow band imaging magnifying endoscopy (NBI-ME) findings and histopathological results, etc. were collected for analysis. Multivariate logistic regression was used to analyze the risk factors for diagnosed as tumor.

Among 402 cases, 33 cases (8.2%) were diagnosed as neoplasia, and 23 cases (5.7%) were high-risk epithelial neoplasia (high grade dysplasia or early gastric cancer). The age of patients, the degree of gastric mucosal atrophy, lesion size, surface depression, NBI-ME positive findings, surface microvessels and surface microstructures were related to neoplasia of gastric mucosal pale lesion (P<0.05). While the age of patients, the degree of gastric mucosal atrophy, lesion size, surface depression, surface microstructures were related to high-risk epithelial neoplasia of gastric mucosal pale lesion (P<0.05). Multivariate logistic regression analysis showed that lesion diameter<20 mm (OR=4.487, 95%CI: 1.776-11.332, P=0.001) and NBI-ME positive findings (OR=40.510, 95%CI: 1.610-1 019.456, P=0.024) were independent risk factors for neoplasia, and abnormal surface microstructure of lesion was an independent risk factor for high-risk epithelial neoplasia (OR=0.003, 95%CI: 0.000-1.587, P<0.001).

Abnormal surface microstructure, the lesion size, and NBI-ME positive findings are important clues for the diagnosis of neoplasia in the pale lesions.

Stomach neoplasms; Diagnosis; Risk factors; Pale lesions