Examination time as a quality indicator of screening upper gastrointestinal endoscopy for asymptomatic examinees

Kawamura, Takuji; Wada, Hironori; Sakiyama, Naokuni; Ueda, Yoshimichi; Shiozaki, Atsushi; Okada, Yusuke; Sanada, Kasumi; Nakase, Kojiro; Mandai, Koichiro; Suzuki, Azumi; Kamaguchi, Mai; Morita, Atsuhiro; Nishioji, Kenichi; Tanaka, Kiyohito; Mochizuki, Naoki; Uno, Koji; Yokota, Isao; Kobayashi, Masao; Yasuda, Kenjiro

doi:10.1111/den.12804

Cited by 51 publications

(57 citation statements)

References 19 publications

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“…Previous studies have shown that slow-speed endoscopists had a higher detection rate for UGI neoplasms than fas- speed endoscopists 23 24 25 . In this study, the neoplasm detection rates showed no significant difference among the fast, moderate, and slow groups.…”

Section: Discussionmentioning

confidence: 93%

“…A few previous studies found an association between inspection time during EGD and detection rates for UGI neoplasms. Results of those studies have shown that slower endoscopists detected a higher proportion of UGI neoplasms than faster endoscopists, suggesting that inspection time may be a useful quality indicator in EGD 23 24 25 . Conversely, other previous studies found that endoscopists require sufficient training and experience to detect gastric cancer properly 12 13 14 .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…In a single-centre retrospective trial in Singapore, endoscopists who spent a mean OGD time of longer than 7 min were twice as likely to detect high-risk lesions (OR 2.50, 95% CI 1.52 to 4.12) and three times as likely to detect neoplastic lesions (OR 3.42, 95% CI 1.25 to 10.38) than their counterparts who conducted shorter examinations 62. A similar Japanese study indicated that moderate (5–7 min) and slow (>7 min) endoscopists for OGD identified about twice as many neoplastic lesions (OR 1.90, 95% CI 1.06 to 3.40, and 1.89, 95% CI 0.98 to 3.64, respectively) than quicker (<5 min) endoscopists 63. Park et al retrospectively analysed the data of 111 962 patients who underwent OGD in a health-screening programme and found that slow endoscopists were more likely to detect gastric adenoma or carcinoma 64…”

Section: Consensus Statementsmentioning

confidence: 89%

An Asian consensus on standards of diagnostic upper endoscopy for neoplasia

Chiu

Uedo²,

Singh

et al. 2018

Gut

122

103

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BackgroundThis is a consensus developed by a group of expert endoscopists aiming to standardise the preparation, process and endoscopic procedural steps for diagnosis of early upper gastrointestinal (GI) cancers.MethodThe Delphi method was used to develop consensus statements through identification of clinical questions on diagnostic endoscopy. Three consensus meetings were conducted to consolidate the statements and voting. We conducted a systematic literature search on evidence for each statement. The statements were presented in the second consensus meeting and revised according to comments. The final voting was conducted at the third consensus meeting on the level of evidence and agreement.ResultsRisk stratification should be conducted before endoscopy and high risk endoscopic findings should raise an index of suspicion. The presence of premalignant mucosal changes should be documented and use of sedation is recommended to enhance detection of superficial upper GI neoplasms. The use of antispasmodics and mucolytics enhanced visualisation of the upper GI tract, and systematic endoscopic mapping should be conducted to improve detection. Sufficient examination time and structured training on diagnosis improves detection. Image enhanced endoscopy in addition to white light imaging improves detection of superficial upper GI cancer. Magnifying endoscopy with narrow-band imaging is recommended for characterisation of upper GI superficial neoplasms. Endoscopic characterisation can avoid unnecessary biopsy.ConclusionThis consensus provides guidance for the performance of endoscopic diagnosis and characterisation for early gastric and oesophageal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early upper GI cancers.

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“…reported that, in 837 cases of endoscopic examination, endoscopists who took a mean <7 min from endoscope insertion to removal did not detect early gastric cancer, whereas those who took a mean of 7 min or more detected four (0.9%) lesions of early gastric cancer. Kawamura et al 2 . analyzed 15,763 endoscopic examinations and found that the detection rate of early gastric cancer tended to be lower among endoscopists who took a mean duration of examination (from endoscope insertion to removal) of <5 min (0.2%) than among those who took a mean duration of 5 min or more (0.4%).…”

Section: Statement 2‐4mentioning

confidence: 99%

Guidelines for endoscopic diagnosis of early gastric cancer

Yao

Uedo

Kamada

et al. 2020

Digestive Endoscopy

149

144

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The Japan Gastroenterological Endoscopy Society developed the Guideline for Endoscopic Diagnosis of Early Gastric Cancer based on scientific methods. Endoscopy for the diagnosis of early gastric cancer has been acknowledged as a useful and highly precise examination, and its use has become increasingly more common in recent years. However, the level of evidence in this field is low, and it is often necessary to determine recommendations based on expert consensus only. This clinical practice guideline consists of the following sections to provide the current guideline: [I] Risk stratification of gastric cancer before endoscopic examination, [II] Detection of early gastric cancer, [III] Qualitative diagnosis of early gastric cancer, [IV] Diagnosis to choose the therapeutic strategy for gastric cancer, [V] Risk stratification after endoscopic examination, and [VI] Surveillance of early gastric cancer.

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Examination time as a quality indicator of screening upper gastrointestinal endoscopy for asymptomatic examinees

Abstract: Endoscopists who do not allot adequate examination time may overlook neoplastic lesions in the upper gastrointestinal tract.

Cited by 51 publications

References 19 publications

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

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

An Asian consensus on standards of diagnostic upper endoscopy for neoplasia

Guidelines for endoscopic diagnosis of early gastric cancer

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