Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.
Dig Dis Sci. 2012 Mar;57(3):746-52. doi: 10.1007/s10620-011-1919-0. Epub 2011 Oct 8.
It is not clear which screening examinations are best suited for gastric cancer prevention, especially in patients with atrophic gastritis and intestinal metaplasia. Therefore, we investigated the gastric cancer screening methods and intervals that are performed in clinical practice in an area with a high prevalence of gastric cancer.
Eighty-seven physicians voted by keypad and discussed the consistency of endoscopic diagnosis of atrophic gastritis and intestinal metaplasia at the Annual Symposium of the Korean College of Helicobacter and Upper Gastrointestinal Research. Additionally, 100 core members of this academic society were asked via e-mail to complete the questionnaires related to screening strategies for gastric cancer.
The most common recommendation for the subjects with intestinal metaplasia was an annual endoscopic follow-up (95.5% vs. 80.4% in the expert and non-expert groups, respectively; P = 0.118). Annual endoscopic follow-up was also the most predominant recommendation for atrophic gastritis (95.5% vs. 76.5%; P = 0.092), regardless of the physicians' endoscopic experience, position, and degree of the hospital. However, the correct answer rate for the diagnosis of normal endoscopic findings was only 16.7 and 14.1% in the expert and non-expert groups, respectively (P = 0.883).
The most common practical screening strategy for patients with atrophic gastritis and intestinal metaplasia in Korea was annual endoscopic examination. However, a new program estimating individualized gastric cancer risk might be needed because of the low inter-observer agreement in the endoscopic diagnosis of atrophic gastritis and intestinal metaplasia.
目前尚不清楚哪种筛查检查最适合用于胃癌预防，尤其是在患有萎缩性胃炎和肠化生的患者中。因此，我们调查了在胃癌高发地区临床实践中进行的胃癌筛查方法和间隔。
87 名医师通过按键投票，并在韩国幽门螺杆菌和上胃肠道研究学院年会上讨论了萎缩性胃炎和肠化生的内镜诊断一致性。此外，通过电子邮件向该学术学会的 100 名核心成员发送了与胃癌筛查策略相关的问卷。
肠化生患者最常见的建议是每年进行内镜随访（专家组和非专家组分别为 95.5%和 80.4%；P=0.118）。无论医师的内镜经验、职位和医院级别如何，萎缩性胃炎患者也最常推荐进行年度内镜随访（95.5%和 76.5%；P=0.092）。然而，在专家组和非专家组中，正确诊断正常内镜表现的比率分别仅为 16.7%和 14.1%（P=0.883）。
在韩国，萎缩性胃炎和肠化生患者最常见的实际筛查策略是每年进行内镜检查。然而，由于萎缩性胃炎和肠化生的内镜诊断观察者间一致性较低，可能需要新的个体化胃癌风险评估方案。
