Interval Advanced Gastric Cancer After Negative Endoscopy,Clinical Gastroenterology and Hepatology

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Interval Advanced Gastric Cancer After Negative Endoscopy
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2022-09-06 , DOI: 10.1016/j.cgh.2022.08.027
Tae Jun Kim ₁ , Jeung Hui Pyo ₂ , Young Hye Byun ₂ , Sung Chul Choi ₂ , Jin Pyo Hong ₂ , Yang Won Min ₁ , Hyuk Lee ₁ , Byung-Hoon Min ₁ , Poong-Lyul Rhee ₁ , Jae J Kim ₁ , Jun Haeng Lee ₁

Affiliation

Background & Aims

Esophagogastroduodenoscopy (EGD) is effective in reducing gastric cancer mortality through detection of early-stage cancer in areas with a high prevalence of gastric cancer. Although the risk of post-endoscopy advanced gastric cancer (AGC) is low, interval AGC remains a concern. We investigated the characteristics and predictors of interval AGC after negative EGD.

Methods

We included 1257 patients with gastric cancer within 6 to 36 months of a “cancer-negative” index EGD between 2005 and 2021 at a tertiary university hospital in South Korea. Observation time on the index EGD was used as a quality indicator. We compared the clinical and endoscopic characteristics and quality indicators between interval AGC and screen-detected early gastric cancer (EGC).

Results

Within 6 to 36 months of negative EGD, 102 AGCs (8.1%) and 1155 EGCs (91.9%) were identified. The percentage of patients with shorter observation time (<3 minutes) in the index EGD was higher in the interval AGC group than in the detected EGC group (P = .002). A multivariable analysis comparing screen-detected EGD and interval AGC was adjusted for age, sex, family history of gastric cancer, H. pylori status, endoscopic findings, and endoscopy-related factors including gastric observation time and interval time. A shorter observation time (<3 minutes) (odds ratio, 2.27; 95% confidence interval, 1.20–4.30), and interval time >2 years (odds ratio, 1.84; 95% confidence interval, 1.04–3.24) were associated with an increased risk of interval AGC.

Conclusion

A shorter observation time during index EGD is an important predictor of interval AGC. Further, withdrawal time longer than 3 minutes may be a quality indicator for screening EGD.

中文翻译：

内镜检查阴性后的间期晚期胃癌

背景与目标

食管胃十二指肠镜检查 (EGD) 通过检测胃癌高发地区的早期癌症，可有效降低胃癌死亡率。尽管内窥镜检查后晚期胃癌 (AGC) 的风险很低，但间隔 AGC 仍然是一个问题。我们研究了负 EGD 后间隔 AGC 的特征和预测因子。

方法

我们纳入了 2005 年至 2021 年在韩国一家三级大学医院进行“癌症阴性”指数 EGD 后 6 至 36 个月内的 1257 名胃癌患者。指数 EGD 的观察时间被用作质量指标。我们比较了间期 AGC 和筛查检测出的早期胃癌 (EGC) 的临床和内镜特征以及质量指标。

结果

在 EGD 阴性的 6 至 36 个月内，确定了 102 个 AGC (8.1%) 和 1155 个 EGC (91.9%)。间隔 AGC 组中指数 EGD 观察时间较短（<3 分钟）的患者百分比高于检测 EGC 组（P = .002）。一项比较屏幕检测到的 EGD 和间隔 AGC 的多变量分析针对年龄、性别、胃癌家族史、幽门螺杆菌状态、内窥镜检查结果和内窥镜检查相关因素（包括胃观察时间和间隔时间）进行了调整。较短的观察时间（<3 分钟）（比值比，2.27；95% 置信区间，1.20–4.30）和间隔时间 >2 年（比值比，1.84；95% 置信区间，1.04–3.24）与间隔 AGC 的风险增加。