Liu Yang, Gu Kaier
Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
Front Med (Lausanne). 2024 Jul 24;11:1389809. doi: 10.3389/fmed.2024.1389809. eCollection 2024.
Esophagogastroduodenoscopy (EGD) is a fundamental procedure for early detection of upper gastrointestinal (UGI) cancer. However, limited research has been conducted on the impact of sedation during EGD on the identification of precancerous lesions and early cancer (EC). This retrospective study aims to evaluate whether sedation during EGD can improve the detection rates of precancerous lesions and EC.
In this propensity score-matched retrospective study, we examined medical records from outpatients who underwent diagnostic EGD at a large tertiary center between January 2023 and December 2023. Data on endoscopic findings and histology biopsies were obtained from an endoscopy quality-control system. The primary objective was to compare the rates of detecting precancerous lesions and EC in patients who received sedation during EGD vs. those who did not receive sedation. Additionally, we aimed to identify factors influencing these detection rates using binary logistic regression analysis.
Following propensity score matching, a total of 17,862 patients who underwent diagnostic EGD with or without propofol sedation were identified. The group that received sedation exhibited a higher detection rate of precancerous lesions and EC in comparison to the non-sedated group (1.04 vs. 0.75%; = 0.039). Additionally, within the sedated group, there was an increased likelihood of identifying precancerous lesions and EC specifically at the gastric antrum (0.60 vs. 0.32%, = 0.006). Binary logistic regression analysis demonstrated that independent risk factors influencing the detection rates included age, gender, observation time, and number of biopsies conducted during the procedure.
Anesthesia assistance during EGD screening proved advantageous in detecting EC as well as precancerous lesions. It is crucial for endoscopists to consider these factors when performing EGD screening procedures.
食管胃十二指肠镜检查（EGD）是早期发现上消化道（UGI）癌的基本检查方法。然而，关于EGD检查期间镇静对癌前病变和早期癌症（EC）识别的影响的研究有限。这项回顾性研究旨在评估EGD检查期间的镇静是否能提高癌前病变和EC的检出率。
在这项倾向评分匹配的回顾性研究中，我们检查了2023年1月至2023年12月期间在一家大型三级中心接受诊断性EGD的门诊患者的病历。内镜检查结果和组织学活检数据来自内镜质量控制系统。主要目的是比较EGD检查期间接受镇静的患者与未接受镇静的患者中癌前病变和EC的检出率。此外，我们旨在使用二元逻辑回归分析确定影响这些检出率的因素。
经过倾向评分匹配后，共识别出17862例接受或未接受丙泊酚镇静的诊断性EGD患者。与未镇静组相比，接受镇静的组癌前病变和EC的检出率更高（1.04%对0.75%；P = 0.039）。此外，在镇静组中，特别是在胃窦部识别癌前病变和EC的可能性增加（0.60%对0.32%，P = 0.006）。二元逻辑回归分析表明，影响检出率的独立危险因素包括年龄、性别、观察时间和检查过程中进行的活检数量。
EGD筛查期间的麻醉辅助被证明有利于检测EC以及癌前病变。内镜医师在进行EGD筛查程序时考虑这些因素至关重要。
