Ishihara Ryu, Hikichi Takuto, Iwaya Yugo, Iijima Katsunori, Imagawa Atsushi, Mabe Katsuhiro, Ito Nobuhito, Suga Tomoaki, Iizuka Toshiro, Nishida Tsutomu, Furumoto Yohei, Muto Manabu, Takeuchi Hiroya
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka City, Osaka, 541-8567, Japan.
Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
Esophagus. 2025 Jan;22(1):47-58. doi: 10.1007/s10388-024-01087-3. Epub 2024 Sep 24.
The practice of endoscopic diagnosis of esophageal squamous cell carcinoma (ESCC) often diverges from evidence-based standards due to various factors, including inadequate dissemination of evidence or a mismatch between evidence and real-world contexts. This survey aimed to identify discrepancies between evidence-based standard practices and community standard practices for ESCC among endoscopists.
An online survey targeting endoscopists who perform upper gastrointestinal endoscopy at least weekly was conducted to collect data on clinical practices related to ESCC diagnosis. The survey, comprising 20 questions, was disseminated through multiple professional networks. Descriptive statistical analysis and logistic regression were performed to analyze the data.
Data from 819 endoscopists were included in the analyses. Notably, a significant proportion employed narrow-band imaging/blue-laser imaging over iodine staining, and preferences varied based on risk assessment for ESCC. In total, 64.0% of endoscopists primarily used iodine solution at a concentration of 1% or less, while 96.5% of endoscopists performed an observation of the oral cavity and the pharynx when conducting upper gastrointestinal endoscopies on individuals at high risk of ESCC. The surveillance interval for metachronous multiple ESCCs was most commonly every 6 months, followed by every 12 months. In addition, most physicians conducted surveillance of metastatic recurrence at 6-month intervals.
This survey highlights significant gaps between evidence-based and community standard practices in the endoscopic diagnosis of ESCC. These findings underscore the need for enhanced dissemination of evidence-based guidelines and consideration of real-world clinical contexts to bridge these gaps and optimize patient care.
由于多种因素，包括证据传播不足或证据与现实情况不匹配，食管鳞状细胞癌（ESCC）的内镜诊断实践往往偏离循证标准。本调查旨在确定内镜医师在ESCC的循证标准实践与社区标准实践之间的差异。
针对至少每周进行一次上消化道内镜检查的内镜医师开展在线调查，以收集与ESCC诊断相关的临床实践数据。该调查包含20个问题，通过多个专业网络进行传播。对数据进行描述性统计分析和逻辑回归分析。
分析纳入了819名内镜医师的数据。值得注意的是，相当一部分人采用窄带成像/蓝光成像而非碘染色，且偏好因ESCC风险评估而异。总体而言，64.0%的内镜医师主要使用浓度为1%或更低的碘溶液，而96.5%的内镜医师在对ESCC高危个体进行上消化道内镜检查时会观察口腔和咽部。异时性多发ESCC的监测间隔最常见为每6个月一次，其次是每12个月一次。此外，大多数医生每6个月进行一次转移复发监测。
本调查凸显了ESCC内镜诊断中循证实践与社区标准实践之间的显著差距。这些发现强调需要加强循证指南的传播，并考虑现实临床情况以弥合这些差距并优化患者护理。
