Endoscopy Unit, Hospital General of Granollers, University of Barcelona, Barcelona.
Endoscopy Unit, Hospital General of Granollers, Granollers.
Eur J Cancer Prev. 2021 Nov 1;30(6):431-436. doi: 10.1097/CEJ.0000000000000648.
Gastric premalignant conditions (GPC) surveillance has been proposed to improve the prognosis of gastric cancer (GC), but the early GC detection rate remaining low, and missing GC during an esophago-gastro-duodenoscopy is still a problem. We aimed to explore the gastroenterologists' attitudes on the detection and management of GPC.
A cross-sectional study was designed based on a survey among gastroenterologists from Asociación Española de Gastroenterología.
The participation rate was 12% (146/1243). Eighty-one percent worked at secondary or tertiary-care hospitals with the capability to perform mucosectomy (80%), but with a lesser availability of endoscopic submucosal dissection (35%). Most respondents had high-definition endoscopes (88%), and virtual chromoendoscopy (86%), but during performing an upper endoscopy, 34% never or rarely use chromoendoscopy, and 73% apply a biopsy protocol often/very often when atrophy or intestinal metaplasia (IM) is suspected. Half of the respondents self-reported their ability to recognize atrophy or IM ≤7 (on a scale from 0 to 10), whereas ≤6 for dysplasia or early GC. Helicobacter pylori infection is eradicated and verified by ≥90%. Endoscopic surveillance of atrophy/IM is performed by 62%. An immediate endoscopy for dysplasia is not always performed. For low-grade dysplasia, 97.6% consider endoscopic management, but for high-grade dysplasia, 23% regard gastric surgery.
There is a wide variability in the detection and management of GPC among Spanish gastroenterologists, and compliance with guidelines and biopsy protocols could be improved. Performance of high-quality gastroscopies including use of virtual chromoendoscopy, that might allow an improvement in the GPC detection, needs also to be generalized.
胃前恶性病变（GPC）监测被提议用于改善胃癌（GC）的预后，但早期 GC 的检出率仍然较低，并且在食管胃十二指肠镜检查期间仍存在漏诊 GC 的问题。我们旨在探讨胃肠病学家对 GPC 的检测和管理的态度。
基于对西班牙胃肠病学会的胃肠病学家的调查，设计了一项横断面研究。
参与率为 12%（146/1243）。81%的人在二级或三级保健医院工作，有能力进行黏膜切除术（80%），但内镜黏膜下剥离术的可用性较低（35%）。大多数受访者都有高清内窥镜（88%）和虚拟染色内镜（86%），但在进行上消化道内镜检查时，34%的人从未或很少使用染色内镜，73%的人在怀疑萎缩或肠上皮化生（IM）时经常/非常经常应用活检方案。一半的受访者自我报告其识别萎缩或 IM 的能力≤7（在 0 到 10 的范围内），而识别异型增生或早期 GC 的能力≤6。幽门螺杆菌感染的根除和验证率≥90%。对萎缩/IM 的内镜监测由 62%的人进行。对异型增生不是总是立即进行内镜检查。对于低级别异型增生，97.6%的人考虑内镜治疗，但对于高级别异型增生，23%的人认为需要胃手术。
西班牙胃肠病学家在 GPC 的检测和管理方面存在很大的差异，并且可以提高对指南和活检方案的依从性。还需要普及包括使用虚拟染色内镜在内的高质量胃镜检查，这可能有助于提高 GPC 的检出率。
