Efficacy and safety of Huazhuojiedu decoction for gastric precancerous lesions after endoscopic submucosal dissection

doi:10.4240/wjgs.122120

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Oct 27, 2026; 18(10): 122120
Published online Oct 27, 2026. doi: 10.4240/wjgs.122120

Table 1 Comparison of baseline characteristics between two groups, n (%)/mean ± SD

Variable	Observation (n = 119)	Control (n = 117)	χ²/t/Z	P value
Gender - male	71 (59.7)	67 (57.3)	0.186	0.666
Gender - female	48 (40.3)	50 (42.7)	-	-
Age (years)	58.34 ± 8.72	57.86 ± 9.15	0.412	0.681
BMI (kg/m²)	23.18 ± 2.86	23.42 ± 2.91	-0.639	0.523
Smoking history	42 (35.3)	38 (32.5)	0.204	0.651
Drinking history	35 (29.4)	31 (26.5)	0.249	0.618
Diabetes history	18 (15.1)	15 (12.8)	0.260	0.610
Hypertension history	32 (26.9)	29 (24.8)	0.137	0.711
Staging - carcinoma in situ	98 (82.4)	95 (81.2)	0.089	0.766
Staging - intramucosal carcinoma	21 (17.6)	22 (18.8)	-	-
Differentiation - well-moderate	103 (86.6)	99 (84.6)	0.324	0.569
Differentiation - poorly differentiated	16 (13.4)	18 (15.4)	-	-
Atrophic gastritis	119 (100.0)	117 (100.0)	-	-
Intestinal metaplasia	108 (90.8)	104 (88.9)	0.225	0.635
LGIN	45 (37.8)	42 (35.9)	0.093	0.760
HGIN	12 (10.1)	14 (12.0)	0.212	0.645
Location - antrum	52 (43.7)	54 (46.2)	0.892	0.827
Location - body	35 (29.4)	31 (26.5)	-	-
Location - angle	23 (19.3)	24 (20.5)	-	-
Location - cardia	9 (7.6)	8 (6.8)	-	-
H. pylori infection	68 (57.1)	64 (54.7)	0.141	0.707
Pre-treatment TCM score	18.52 ± 5.36	18.21 ± 5.48	0.439	0.661

BMI: Body mass index; LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia; TCM: Traditional Chinese medicine; H. pylori: Helicobacter pylori.

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Table 2 Comparison of histopathological efficacy between two groups, n (%)

Group	n	Reversal	Improvement	Stable	Progression
Observation	119	25 (21.0)	50 (42.0)	37 (31.1)	7 (5.9)
Control	117	12 (10.3)	34 (29.1)	55 (47.0)	16 (13.7)
Z/P value	-	Z = -3.284	P = 0.001	-	-

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Table 3 Comparison of clinical efficacy between the two groups, n (%)

Group	n	Marked	Effective	Ineffective	Progression	Total effective rate
Observation	119	28 (23.5)	47 (39.5)	37 (31.1)	7 (5.9)	75 (63.0)
Control	117	14 (12.0)	32 (27.4)	55 (47.0)	16 (13.7)	46 (39.3)
Z/P value	-	-	Z = -3.412	P < 0.001	-	-

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Table 4 Comparison of histopathological scores before and after treatment, mean ± SD

Group	Time	Atrophy	Intestinal metaplasia	Intraepithelial neoplasia	Total
Observation (n = 119)	Before	2.15 ± 0.68	1.89 ± 0.72	1.18 ± 1.24	5.22 ± 1.86
Observation (n = 119)	After	1.52 ± 0.71^a	1.28 ± 0.69^a	0.54 ± 0.82^a	3.34 ± 1.58^a
Control (n = 117)	Before	2.11 ± 0.65	1.85 ± 0.74	1.22 ± 1.28	5.18 ± 1.92
Control (n = 117)	After	1.82 ± 0.69^a	1.58 ± 0.72^a	0.86 ± 1.05^a	4.26 ± 1.74^a
t/P value (after)	-	-3.297/0.001	-3.275/0.001	-2.622/0.009	-4.269/< 0.001

^aP < 0.05 vs pre-treatment within the same group.

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Table 5 Comparison of traditional Chinese medicine syndrome scores between the two groups, mean ± SD

Group	n	Before	3 months	Completion
Observation	119	18.52 ± 5.36	11.86 ± 4.28^a^,^b	7.24 ± 3.56 ^a^,^b^,^c
Control	117	18.21 ± 5.48	14.35 ± 4.86^a	10.82 ± 4.15^a^,^c
t/P value	-	0.439/0.661	-4.189/< 0.001	-7.139/< 0.001

^aP < 0.017 vs pre-treatment.

^bP < 0.017 vs control.

^cP < 0.017 vs 3 months.

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Table 6 Comparison of traditional Chinese medicine syndrome efficacy between two groups, n (%)

Group	n	Cure	Marked	Effective	Ineffective	Total effective rate
Observation	119	15 (12.6)	45 (37.8)	42 (35.3)	17 (14.3)	102 (85.7)
Control	117	6 (5.1)	28 (23.9)	42 (35.9)	41 (35.0)	76 (65.0)
Z/P value	-	-	-	Z = -3.658	P < 0.001	-

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Table 7 Comparison of gastric function indicators, mean ± SD

Group	Time	PGI (μg/L)	PGII (μg/L)	PGR	G-17 (pmol/L)
Observation (n = 119)	Before	68.52 ± 18.34	15.86 ± 5.42	4.32 ± 1.38	5.86 ± 2.34
Observation (n = 119)	After	82.76 ± 19.85^a	13.24 ± 4.56^a	6.25 ± 1.82^a	8.34 ± 2.86^a
Control (n = 117)	Before	67.86 ± 17.92	15.62 ± 5.28	4.34 ± 1.42	5.72 ± 2.28
Control (n = 117)	After	75.42 ± 18.68^a	14.28 ± 4.82^a	5.28 ± 1.65^a	7.12 ± 2.64^a
t/P value (after)		3.012/0.003	-1.718/0.087	4.326/< 0.001	3.426/< 0.001

^aP < 0.05 vs pre-treatment within the same group.

PGI: Pepsinogen I; PGII: Pepsinogen II; PGR: Pepsinogen I/II ratio.

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Table 8 Comparison of inflammatory factor levels, mean ± SD

Group	Time	IL-6 (pg/mL)	IL-8 (pg/mL)	TNF-α (pg/mL)
Observation (n = 119)	Before	28.56 ± 8.72	42.35 ± 12.68	35.82 ± 10.45
Observation (n = 119)	After	18.92 ± 6.54^a	28.64 ± 9.86^a	24.18 ± 8.26^a
Control (n = 117)	Before	29.12 ± 8.45	43.12 ± 12.34	36.24 ± 10.18
Control (n = 117)	After	23.45 ± 7.82^a	35.28 ± 10.92^a	29.86 ± 9.12^a
t/P value (after)		-4.836/< 0.001	-4.920/< 0.001	-5.032/< 0.001

^aP < 0.05 vs pre-treatment within the same group.

IL: Interleukin; TNF-α: Tumor necrosis factor-α.

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Table 9 Comparison of gastrointestinal quality-of-life index score scores before and after treatment, mean ± SD

Group	Time	GI symptoms	Physical	Emotional	Social	Treat	Total
Observation (n = 119)	Before	42.56 ± 8.34	18.24 ± 4.52	12.86 ± 3.28	7.52 ± 2.15	5.24 ± 1.56	86.42 ± 15.62
Observation (n = 119)	After	58.72 ± 9.18^a	24.35 ± 4.86^a	17.24 ± 3.45^a	10.18 ± 2.34^a	6.85 ± 1.42^a	117.34 ± 16.85^a
Control (n = 117)	Before	42.18 ± 8.56	18.12 ± 4.68	12.72 ± 3.35	7.45 ± 2.22	5.18 ± 1.62	85.65 ± 16.24
Control (n = 117)	After	51.45 ± 8.86^a	21.56 ± 4.72^a	15.18 ± 3.52^a	8.86 ± 2.28^a	6.52 ± 1.48^a	103.57 ± 16.42^a
t (after)		6.204	4.505	4.571	4.418	1.756	6.385
P value (after)		< 0.001	< 0.001	< 0.001	< 0.001	0.080	< 0.001

^aP < 0.05 vs pre-treatment within the same group.

GI: Gastrointestinal.

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Table 10 Metachronous gastric cancer and precancerous lesion progression, n (%)

Group	n	Metachronous GC	χ²/P value	PL progression	χ²/P value
Observation	116	2 (1.7)	4.125/0.042	9 (7.8)	6.852/0.009
Control	112	6 (5.4)	-	21 (18.8)	-

n denotes patients with complete follow-up (observation 116, control 112) after excluding 8 Losses to follow-up.

GC: Gastric cancer; PL: Precancerous lesion.

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Table 11 Cox regression analysis of factors affecting precancerous lesion progression

Variable	Univariate HR (95%CI)	Univariate P	Multivariate HR (95%CI)	Multivariate P
Age (≥ 65 vs < 65)	1.682 (0.886-3.194)	0.112	-	-
Gender (male vs female)	1.124 (0.568-2.224)	0.736	-	-
BMI (≥ 24 vs < 24)	0.892 (0.456-1.745)	0.738	-	-
Smoking (yes vs no)	1.524 (0.792-2.932)	0.208	-	-
Drinking (yes vs no)	1.436 (0.724-2.848)	0.302	-	-
Diabetes (yes vs no)	1.386 (0.624-3.078)	0.422	-	-
Hypertension (yes vs no)	1.245 (0.612-2.534)	0.546	-	-
Poorly differentiation (yes vs no)	1.724 (0.786-3.782)	0.174	-	-
HGIN (yes vs no)	3.856 (1.892-7.862)	< 0.001	3.286 (1.524-7.086)	0.002
Score ≥ 6 (yes vs no)	2.724 (1.386-5.352)	0.004	2.458 (1.182-5.112)	0.016
Cardia (yes vs no)	1.856 (0.824-4.182)	0.135	-	-
HJD treatment (yes vs no)	0.362 (0.172-0.762)	0.007	0.385 (0.178-0.832)	0.015

HR: Hazard ratio; BMI: Body mass index; HGIN: High-grade intraepithelial neoplasia; HJD: Huazhuojiedu decoction.

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Table 12 Comparison of adverse reactions between two groups, n (%)

Adverse reaction	Observation (n = 119)	Control (n = 117)
Nausea	4 (3.4)	4 (3.4)
Diarrhea	5 (4.2)	3 (2.6)
Abdominal pain	3 (2.5)	2 (1.7)
Constipation	0 (0.0)	2 (1.7)
Rash	2 (1.7)	0 (0.0)
Mild liver function abnormality	1 (0.8)	0 (0.0)
Total	15 (12.6)	11 (9.4)
χ²/P value	0.612	0.434

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Citation: Si YJ, Ren NN, Wang JY, Hao XY, Wang ZJ, Li HX, Ge XF, An J, Shi XS, Shen T, Liang J, Ouyang XJ, Wang XY, Wang YG. Efficacy and safety of Huazhuojiedu decoction for gastric precancerous lesions after endoscopic submucosal dissection. World J Gastrointest Surg 2026; 18(10): 122120
URL: https://www.wjgnet.com/1948-9366/full/v18/i10/122120.htm
DOI: https://dx.doi.org/10.4240/wjgs.122120

Si YJ, Ren NN, Wang JY, Hao XY, Wang ZJ, Li HX, Ge XF, An J, Shi XS, Shen T, Liang J, Ouyang XJ, Wang XY, Wang YG. Efficacy and safety of Huazhuojiedu decoction for gastric precancerous lesions after endoscopic submucosal dissection. World J Gastrointest Surg 2026; 18(10): 122120 [DOI: 10.4240/wjgs.122120]

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