Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Clin Gastroenterol Hepatol. 2023 May;21(5):1205-1213.e2. doi: 10.1016/j.cgh.2022.08.027. Epub 2022 Sep 6.
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.
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).
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.
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.
食管胃十二指肠镜检查（EGD）通过检测高发地区的早期胃癌，有效降低了胃癌死亡率。尽管内镜检查后进展期胃癌（AGC）的风险较低，但仍需要关注间隔期 AGC。本研究旨在探讨阴性 EGD 后间隔期 AGC 的特征和预测因素。
本研究纳入了 2005 年至 2021 年期间，在韩国一家三级大学医院接受“阴性”指数 EGD 后 6 至 36 个月内确诊为胃癌的 1257 例患者。指数 EGD 观察时间被用作质量指标。我们比较了间隔期 AGC 和筛查发现的早期胃癌（EGC）的临床和内镜特征及质量指标。
在阴性 EGD 后 6 至 36 个月内，发现 102 例 AGC（8.1%）和 1155 例 EGC（91.9%）。间隔期 AGC 组中，指数 EGD 观察时间较短（<3 分钟）的患者比例高于筛查发现的 EGC 组（P<0.001）。比较筛查发现的 EGC 和间隔期 AGC 的多变量分析调整了年龄、性别、胃癌家族史、H. pylori 状态、内镜表现以及包括胃观察时间和间隔时间在内的内镜相关因素。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）与间隔期 AGC 的风险增加相关。
指数 EGD 期间较短的观察时间是间隔期 AGC 的重要预测因素。此外，3 分钟以上的退镜时间可能是筛查 EGD 的质量指标。
