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Clin Gastroenterol Hepatol. 2015 Mar;13(3):480-487.e2. doi: 10.1016/j.cgh.2014.07.059. Epub 2014 Aug 10.

Longer examination time improves detection of gastric cancer during diagnostic upper gastrointestinal endoscopy.

Author information

1
Department of Surgery, National University Health System, National University of Singapore, Singapore.
2
Department of Surgery, National University of Singapore, Singapore.
3
Health Services and Outcomes Research, National Healthcare Group, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
4
Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.
5
Department of Surgery, National University Health System, National University of Singapore, Singapore; Department of Surgery, National University of Singapore, Singapore.
6
Department of Surgery, National University Health System, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden.
7
Department of Surgery, National University Health System, National University of Singapore, Singapore; Department of Surgery, National University of Singapore, Singapore. Electronic address: jimmy_so@nuhs.edu.sg.

Abstract

BACKGROUND & AIMS:

It is not clear how the duration of upper endoscopy affects the detection of cancer or premalignant lesions that increase the risk for gastric cancer. We investigated whether the length of time spent performing esophagogastroduodenoscopy (EGD) affects the detection of important pathologic features of the stomach.

METHODS:

We collected data from 837 symptomatic patients, during a 3-month period in 2010, who underwent a first diagnostic EGD at a tertiary university hospital in Singapore. Endoscopists were classified as fast or slow based on the mean amount of time it took them to perform a normal EGD examination. We used logistic regression to compare between groups the numbers of intestinal metaplasias, gastric atrophies, dysplasias, and cancers detected, using histologic analysis of biopsy samples collected during endoscopy as the standard.

RESULTS:

Of 224 normal endoscopies, the mean duration was 6.6 minutes (range, 2-32 min). When we used 7 minutes as the cut-off time, 8 endoscopists were considered to have short mean examination times (mean duration, 5.5 ± 2.1 min; referred to as fast endoscopists), and 8 endoscopists were considered to have long mean examination times (mean duration, 8.6 ± 4.2 min; referred to as slow endoscopists). Eleven cancers and 81 lesions considered to pose risks for cancer were detected in 86 patients; 1.3% were determined to be cancer, 1.0% were determined to be dysplasia, and 8.7% were determined to be intestinal metaplasia and/or gastric atrophy. Slow endoscopists were twice as likely to detect high-risk lesions as fast endoscopists (odds ratio, 2.50; 95% confidence interval, 1.52-4.12), regardless of whether they were endoscopy staff or trainees. The slow endoscopists also detected 3-fold more neoplastic lesions (cancer or dysplasia; odds ratio, 3.42; 95% confidence interval, 1.25-10.38).

CONCLUSIONS:

Endoscopists with mean EGD examination times longer than 7 minutes identified a greater number of high-risk gastric lesions than faster endoscopists. Examination time may be a useful indicator of quality assessment for upper endoscopy. Studies are required to test these findings in different populations.

KEYWORDS:

Early Detection; Endoscopic; Stomach Cancer; Tumor

PMID:
25117772
DOI:
10.1016/j.cgh.2014.07.059
[Indexed for MEDLINE]

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