Differences in upper gastrointestinal neoplasm detection rates based on inspection time and esophagogastroduodenoscopy training

Abstract

Background and study aims Esophagogastroduodenoscopy (EGD) has utility in early detection of upper gastrointestinal (UGI) neoplasms. However, previous studies report shorter inspection times and inexperienced endoscopists contribute to overlooking gastric neoplasms. We investigated neoplasm detection rates according to inspection time and extent of EGD training. Patients and methods In this retrospective observational study, we reviewed routine EGDs for 3,925 consecutive cases between October 2014 and March 2015. We divided the endoscopists into three groups based on median inspection time during EGD without undergoing biopsy. Using cut-off median inspection times of 7 and 10 minutes, three, five, and eight endoscopists were classified into the fast, moderate, and slow groups, respectively. We compared detection rates according to inspection time and the extent of EGD training. Results The median inspection time among all endoscopists was 9.3 minutes (range, 6.6 – 12.0 min). The detection rate for UGI neoplasms was as follows: fast group, 3.6%; moderate group, 3.3 %; and slow group, 3.1 % ( P = 0.807). The median inspection time was significantly shorter among the intensive training ≥ 1-year group than among the < 1-year group (< 1-year: median 6.3 min; range 8.2 – 13.9 min, ≥ 1-year: median 8.9 min; range 6.4 – 11.4 min, P < 0.001). The detection rate for UGI neoplasms was significantly higher among the intensive training ≥ 1-year group than among the < 1-year group (< 1-year: 2.2 %; ≥ 1-year: 3.7 %, OR = 1.65, 95 % CI: 1.02 – 2.68, P = 0.041). Conclusions There was no association between inspection times and neoplasm detection rates. The quality of EGD, as measured by neoplasm detection rates, may be improved by ≥ 1-year of intensive training.

Initial results from a multi-center population-based cluster randomized trial of esophageal and gastric cancer screening in China

“…We also observed a lower complication rate in high-risk areas than in non-high-risk areas and in previous reports [ 18 ]. The study design of both cancers’ screening, the high-risk exposure of the population living in the areas which results in high prevalence of the diseases, and the extensive training of endoscopic techniques were potential explanatory factors for the high yield of screening results in these high-risk areas [ 19 ].…”

Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer

“…There have been several guidelines providing recommendations on the diagnosis and management of patients at risk of gastric cancer, as well as minimum standards for standard and image-enhanced endoscopy [ 57 , 113 , 149 , 150 , 151 , 152 ]. Standards have included recommendations for minimal inspection time of those with premalignant lesions (7 to 10 min) [ 153 , 154 , 155 , 156 , 157 ], as well as learning curves for training [ 155 ].…”

Current status and future perspective of artificial intelligence applications in endoscopic diagnosis and management of gastric cancer

“…It is sometimes difficult to distinguish benign lesion (gastritis, erosion, and gastric ulcer) from EGC, and the positive predictive value for cancer by biopsy using conventional endoscopy with white light is 3.2-5.6%. 9,32 Namikawa et al 33 evaluated AI [mainly trained by GC (original AI) and advanced AI] by adding gastric ulcer images to the original AI. The overall accuracies of the original and advanced AI for classifying EGC and gastric ulcer were 45.9% and 95.9%, respectively.…”

“…It is sometimes difficult to distinguish benign lesion (gastritis, erosion, and gastric ulcer) from EGC, and the positive predictive value for cancer by biopsy using conventional endoscopy with white light is 3.2–5.6% 9,32 . Namikawa et al 33 .…”

“…4 Although early detection and treatment of GC is important for the prognosis, the rate of false-negative detection of GC by esophagogastroduodenoscopy (EGD) is reported to be 4.6-25.8%, with a higher rate of false-negative detection by inexperienced endoscopists. [5][6][7][8][9] In addition, there is a large variation in the diagnostic ability of endoscopists regarding the differentiation between GC and gastritis, prediction of the horizontal extent of GC, and depth of invasion of GC.…”