Longer Examination Time Improves Detection of Gastric Cancer During Diagnostic Upper Gastrointestinal Endoscopy

Teh, Jun Liang; Tan, Jerry; Lau, Linus; Saxena, Nakul; Salim, Agus; Tay, Amy Yuh Ling; Shabbir, Asim; Chung, Sydney S.C.; Hartman, Mikael; So, Jimmy Bok Yan

doi:10.1016/j.cgh.2014.07.059

Cited by 146 publications

(126 citation statements)

References 20 publications

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“…37 In a study from Singapore, where the detection rate of gastric neoplasia was correlated with the duration of gastroscopy, the investigators demonstrated a threefold increase in findings for those endoscopists with a mean examination time of at least 7 min compared with those who were spending less time on their examination. 74 These findings warrant further study, in particular in Western populations where such studies have not been performed for gastric lesions. However, although longer procedure durations can benefit outcomes, a limit does seem to exist.…”

Section: Perspectivesmentioning

confidence: 93%

Optimizing early upper gastrointestinal cancer detection at endoscopy

Veitch

Uedo

Yao

et al. 2015

Nat Rev Gastroenterol Hepatol

106

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Survival rates for upper gastrointestinal cancers are poor and oesophageal cancer incidence is increasing. Upper gastrointestinal cancer is also often missed during examinations; a predicament that has not yet been sufficiently addressed. Improvements in the detection of premalignant lesions, early oesophageal and gastric cancers will enable organ-preserving endoscopic therapy, potentially reducing the number of advanced upper gastrointestinal cancers and resulting in improved prognosis. Japan is a world leader in high-quality diagnostic upper gastrointestinal endoscopy and the clinical routine in this country differs substantially from Western practice. In this Perspectives article, we review lessons learnt from Japanese gastroscopy technique, training and screening for risk stratification. We suggest a key performance indicator for upper gastrointestinal endoscopy with a minimum total procedure time of 8 min, and examine how quality assurance concepts in bowel cancer screening in the UK could be applied to upper gastrointestinal endoscopy and improve clinical practice.

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Section: Perspectivesmentioning

confidence: 93%

Optimizing early upper gastrointestinal cancer detection at endoscopy

Veitch

Uedo

Yao

et al. 2015

Nat Rev Gastroenterol Hepatol

106

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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.…”

Section: Consensus Statementsmentioning

confidence: 99%

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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“…In contrast to the detection of colon polyps, where a solid scientific basis seems to exist with regard to the measurement of inspection time during withdrawal 3,19 as a performance measure, for UGI endoscopy there is a paucity of scientific data. 9,10 Nonetheless, it seems reasonable to assume that a lengthier inspection of Barrett's esophagus may result in better lesion detection. The optimal inspection time also includes rinsing the esophagus sufficiently to improve visualization, proper sedation and patient tolerance, and the use of high definition endoscopy (i.e.…”

Section: -13mentioning

confidence: 99%

“…This was a retrospective cohort study by Teh et al 9 that aimed to determine the 10 Only one study has evaluated the correlation between increased detection of gastric dysplasia or gastric cancer and other UGI endoscopic diagnoses. 11 Park et al retrospectively analyzed 54,889 records of patients who underwent a screening UGI endoscopy, performed by 66 experienced endoscopists, from 2006-2013 in a single center in Korea.…”

Section: Domain: Completeness Of Proceduresmentioning

confidence: 99%