Differences in routine esophagogastroduodenoscopy between Japanese and international facilities: A questionnaire survey

Abstract

Background and Aim: The mortality rate of gastric cancer (GC) is close to the incidence rate worldwide. However, in Korea and Japan, the mortality rate of GC is less than half of the incidence rate. We hypothesized that good-quality routine esophagogastroduodenoscopy (EGD) contributes to a high detection rate for early GC (EGC) and improves mortality in these countries. Methods:To clarify the differences in routine EGD, a questionnaire survey was conducted in 98 Japanese and 53 international institutions.Results: Prevalence of screening examination among routine EGD was higher in Japanese than in international institutions. Japanese endoscopists noted that endoscopic mucosal atrophy was the most significant risk factor for GC, whereas international endoscopists paid more attention to clinical information such as age, symptoms and family history. Antispasmodics, mucolytics and defoaming agents were used more frequently in Japanese institutions. The examination time was similar (mostly 5-10 min) between Japanese and international institutions. Japanese endoscopists took more pictures (>20 in almost all institutions) than international endoscopists (≤20 in two-thirds of institutions). In Japanese institutions, biopsy specimens were more frequently taken from areas of mucosal discoloration, unevenness or spontaneous bleeding rather than from obvious endoscopic lesions such as ulceration or polyps. In most Japanese institutions, one or two biopsy specimens were taken per lesion, compared with ≥three in international institutions.Conclusion: There were some discrepancies between Japanese and international institutions for routine EGD. Thus, standardization is required for adequate risk assessment, proper techniques, and knowledge of endoscopic diagnosis of EGC.

An Asian consensus on standards of diagnostic upper endoscopy for neoplasia

“…Examination time remains one of the most subjective operator dependent aspects of diagnostic endoscopy 60. Ideally, the longer the examination time, the better the detection rate of significant pathologies during endoscopy.…”

Diagnostic performance of routine esophagogastroduodenoscopy using magnifying endoscope with narrow‐band imaging for gastric cancer

“…7 Although the effectiveness of magnifying endoscopes for EGD can be predicted, the actual diagnostic performance is still not clarified. GIF-H260Z is thicker than other nonmagnifying endoscopes, and therefore is not suitable for routine EGD.…”

Principles and practice to facilitate complete photodocumentation of the upper gastrointestinal tract: World Endoscopy Organization position statement

“…The number of images recorded during an EGD is not standardized and in most facilities worldwide only a relatively small number of endoscopic images are stored for each examination. Although some Japanese referral centers recommend at least 40 non‐alphanumeric stomach images, the ESGE has recently increased from eight to a 10‐image study . The above proposals, however, are quite different to a total upper tract mucosal photodocumentation and cannot be considered indicators of completeness.…”

“…High‐quality photodocumentation of the entire mucosal lining would not be possible without a cleansing protocol similar to bowel preparation before colonoscopy. Although the use of mucosal preparation for increasing early cancer detection is still unproven, this practice is considered safe even in sedated patients and results in better visualization; hence, increasing the likelihood of detecting lesions . In Japan, a mixture of 20 000 U mucolytic agent Pronase (Kaken Pharmaceutical Co., Ltd, Tokyo, Japan), 80 mg anti‐foaming agent dimethylpolysiloxane (Kissei Pharmaceutical Co., Ltd, Matsumoto, Japan) and 1 g Na+ bicarbonate diluted in 50 mL water have been used prior to the exam with demonstrated effectiveness .…”

“…Although esophagogastroduodenoscopy (EGD) is the most commonly used procedure in the gastrointestinal (GI) tract, the method of esophageal, gastric and duodenal mucosa photodocumentation varies considerably worldwide . One probable explanation is that for generations, EGD has primarily been taught by GI faculty and instructors based on their perceptions and experience, which has resulted in EGD currently considered a non‐standardized procedure .…”