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Sakai H, Iwai N, Dohi O, Oka K, Okuda T, Tsuji T, Okabe K, Ohara T, Kajiwara-Kubtota M, Fukui H, Sakagami J, Kagawa K, Inoue K, Yoshida N, Uchiyama K, Takagi T, Konishi H, Itoh Y. Effect of texture and color enhancement imaging on the visibility of gastric tumors. Sci Rep 2024; 14:19125. [PMID: 39155293 PMCID: PMC11330958 DOI: 10.1038/s41598-024-70236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/14/2024] [Indexed: 08/20/2024] Open
Abstract
Texture and color enhancement imaging (TXI) may improve the visibility of gastric tumors and allow their early detection. However, few reports have examined the utility of TXI. Between June 2021 and October 2022, 56 gastric tumors in 51 patients undergoing endoscopic submucosal dissection at Fukuchiyama City Hospital were evaluated preoperatively using conventional white light imaging (WLI), narrow-band imaging (NBI), and TXI modes 1 and 2. The color differences of the tumors and surrounding mucosae were evaluated using the CIE 1976 L*a*b color space, Additionally, the visibility scores were scaled. Of the 56 gastric tumors, 45 were early gastric cancers, and 11 were adenomas. Overall, the color difference in TXI mode 1 was considerably higher compared to WLI (16.36 ± 7.05 vs. 10.84 ± 4.05; p < 0.01). Moreover, the color difference in early gastric cancers was considerably higher in TXI mode 1 compared to WLI, whereas no significant difference was found in adenomas. The visibility score in TXI mode 1 was the highest, and it was significantly higher compared to WLI. Regarding adenomas, the visibility score in TXI mode 1 was also significantly higher compared to that in WLI. TXI may provide improved gastric tumor visibility.
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Affiliation(s)
- Hiroaki Sakai
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Naoto Iwai
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan.
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kohei Oka
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takashi Okuda
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshifumi Tsuji
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Kengo Okabe
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomoya Ohara
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Mariko Kajiwara-Kubtota
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Hayato Fukui
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Junichi Sakagami
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Keizo Kagawa
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Ken Inoue
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohisa Yoshida
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiko Uchiyama
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomohisa Takagi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideyuki Konishi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshito Itoh
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi Hirokoji Kamigyo-ku, Kyoto, 602-8566, Japan
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Kato M, Ono S, Kawada K, Dohi O, Kitamura S, Koike T, Hori S, Kanzaki H, Murao T, Yagi N, Sasaki F, Hashiguchi K, Oka S, Katada K, Shimoda R, Mizukami K, Suehiro M, Takeuchi T, Katsuki S, Tsuda M, Naito Y, Kawano T, Haruma K, Mori K, Ishikawa H. Diagnostic performance of linked color imaging for gastric cancer by Helicobacter pylori infection status: A subanalysis of the large-scale, multicenter randomized controlled trial LCI-FIND. Helicobacter 2024; 29:e13080. [PMID: 38671594 DOI: 10.1111/hel.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Linked color imaging (LCI) is a new image enhancement technology that facilitates the recognition of subtle differences in mucosal color. In the large-scale, multicenter randomized controlled trial LCI-FIND, LCI demonstrated good diagnostic performance for the detection of tumor lesions in the upper gastrointestinal tract. The aim of the present study was to exploratively evaluate the diagnostic performance of LCI according to H. pylori infection status as a subanalysis of LCI-FIND trial. METHODS The patients were randomly allocated to receive white light imaging (WLI) first, followed by LCI (WLI group), or vice versa (LCI group), and the two groups were compared for the detection of tumors. Data from this trial were analyzed by the presence/absence of H. pylori infection and further analyzed by successful or unsuccessful eradication in the H. pylori infection group. RESULTS The 752 patients in the WLI group and 750 patients in the LCI group who had participated in the LCI-FIND trial were included. In the successful eradication group, more gastric lesions were detected by primary mode in the LCI group than in the WLI group, indicating that more lesions were missed by WLI. Fisher's exact probability test for the comparison of the WLI and LCI groups yielded a p-value of 0.0068, with missed gastric lesions being detected 0.136 times (95% confidence interval: 0.020-0.923), significantly less with LCI than with WLI. CONCLUSION The current study suggests that LCI should be used for gastric cancer screening, particularly in patients with successful H. pylori eradication.
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Affiliation(s)
- Mototsugu Kato
- Public Interest Foundation Hokkaido Cancer Society, Sapporo, Hokkaido, Japan
- Department of Gastroenterology, National Hospital organization Hakodate National Hospital, Hakodate, Hokkaido, Japan
| | - Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kenro Kawada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shinichiro Hori
- Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takahisa Murao
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiro Katada
- Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Shimoda
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
| | | | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Shinichi Katsuki
- Department of Gastroenterology, Otaru Ekisaikai Hospital, Otaru, Hokkaido, Japan
| | - Momoko Tsuda
- Public Interest Foundation Hokkaido Cancer Society, Sapporo, Hokkaido, Japan
- Department of Gastroenterology, National Hospital organization Hakodate National Hospital, Hakodate, Hokkaido, Japan
| | - Yuji Naito
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Keita Mori
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Osaka, Japan
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Feng J, Yu SR, Zhang YP, Qu L, Wei L, Wang PF, Zhu LJ, Bao Y, Lei XG, Gao LL, Feng YH, Yu Y, Huang XJ. A system based on deep convolutional neural network improves the detection of early gastric cancer. Front Oncol 2022; 12:1021625. [PMID: 36620563 PMCID: PMC9815521 DOI: 10.3389/fonc.2022.1021625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background Early gastric cancer (EGC) has a high survival rate, but it is difficult to diagnosis. Recently, artificial intelligence (AI) based on deep convolutional neural network (DCNN) has made significant progress in the field of gastroenterology. The purpose of this study was to establish a DCNN assist system to improve the detection of EGC. Methods 3400 EGC and 8600 benign images were collected to train the DCNN to detect EGC. Subsequently, its diagnostic ability was compared to that of endoscopists using an independent internal test set (ITS, including 1289 images) and an external test set (ETS, including 542 images) come from three digestive center. Results The diagnostic time of DCNN and endoscopists were 0.028s, 8.05 ± 0.21s, 7.69 ± 0.25s in ITS, and 0.028s, 7.98 ± 0.19s, 7.50 ± 0.23s in ETS, respectively. In ITS, the diagnostic sensitivity and accuracy of DCNN are 88.08%(95% confidence interval,95%CI,85.24%-90.44%), 88.60% (95%CI,86.74%-90.22%), respectively. In ETS, the diagnostic sensitivity and accuracy are 92.08% (95%CI, 87.91%- 94.94%),92.07%(95%CI, 89.46%-94.08%),respectively. DCNN outperformed all endoscopists in ETS, and had a significantly higher sensitivity than the junior endoscopists(JE)(by18.54% (95%CI, 15.64%-21.84%) in ITS, also higher than JE (by21.67%,95%CI, 16.90%-27.32%) and senior endoscopists (SE) (by2.08%, 95%CI, 0.75%-4.92%)in ETS. The accuracy of DCNN model was higher (by10.47%,95%CI, 8.91%-12.27%) than that of JE in ITS, and also higher (by14.58%,95%CI, 11.84%-17.81%; by 1.94%,95%CI,1.25%-2.96%, respectively) than JE and SE in ETS. Conclusion The DCNN can detected more EGC images in a shorter time than the endoscopists. It will become an effective tool to assist in the detection of EGC in the near future.
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Affiliation(s)
- Jie Feng
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu, China,Technology Research and Development Department, Digestive Endoscopy Engineering Research and Development Center of Gansu Province, Lanzhou, Gansu, China
| | - Shang rui Yu
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yao ping Zhang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu, China,Technology Research and Development Department, Digestive Endoscopy Engineering Research and Development Center of Gansu Province, Lanzhou, Gansu, China
| | - Lina Qu
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu, China,Technology Research and Development Department, Digestive Endoscopy Engineering Research and Development Center of Gansu Province, Lanzhou, Gansu, China
| | - Lina Wei
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Peng fei Wang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Li juan Zhu
- Department of Sciences and Technology, Beijing Huag gen Anbang Technology Technology Company Limited, Beijing, China
| | - Yanfeng Bao
- Department of Sciences and Technology, Beijing Huag gen Anbang Technology Technology Company Limited, Beijing, China
| | - Xiao gang Lei
- Department of Gastroenterology, Lanzhou Cheng guan District People’s Hospital, Lanzhou, Gansu, China
| | - Liang liang Gao
- Department of Gastroenterology, Min County People’s Hospital, Ding Xi, Gansu, China
| | - Yan hu Feng
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yi Yu
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xiao jun Huang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, Gansu, China,Technology Research and Development Department, Digestive Endoscopy Engineering Research and Development Center of Gansu Province, Lanzhou, Gansu, China,*Correspondence: Xiao jun Huang,
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4
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Haruma K, Kato M, Kawada K, Murao T, Ono S, Suehiro M, Hori S, Sasaki F, Koike T, Kitamura S, Dohi O, Kanzaki H, Yagi N, Hashiguchi K, Oka S, Katada K, Shimoda R, Mizukami K, Takeuchi T, Katsuki S, Tsuda M, Naito Y, Kawano T, Mori K, Ishikawa H. Diagnostic ability of linked color imaging in ultraslim endoscopy to identify neoplastic lesions in the upper gastrointestinal tract. Endosc Int Open 2022; 10:E88-E95. [PMID: 35047338 PMCID: PMC8759938 DOI: 10.1055/a-1723-2635] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background and study aims Linked color imaging (LCI) is a new image-enhancing technique that facilitates the differentiation of slight differences in mucosal color tone. We performed an exploratory analysis to evaluate the diagnostic capability of LCI in ultraslim endoscopy, using data from patients examined in the LCI-Further Improving Neoplasm Detection in upper gastrointestinal (LCI-FIND) trial, a large-scale, multicenter, randomized controlled trial that demonstrated the capability of LCI for detecting neoplastic lesions in the upper gastrointestinal tract. Patients and methods Data from the LCI-FIND prospective trial were used. In the LCI-FIND trial, 1502 patients with a history of gastrointestinal cancer were randomly assigned to two groups based on examination methods: white light imaging (WLI) followed by LCI (WLI group) and LCI followed by WLI (LCI group). The present exploratory analysis investigated the outcomes of patients who underwent ultraslim and standard endoscopies. Results Ultraslim endoscopes were used in 223 patients and standard endoscopes in 1279 patients. The primary endpoint of the LCI-FIND trial was the percentage of patients diagnosed with a neoplastic lesion using WLI or LCI. The corresponding percentage tended to be higher with LCI than with WLI among patients who underwent ultraslim endoscopy and among those who underwent standard endoscopy; the crude risk ratio was 2.21 [95 % confidence interval (CI): 1.06-4.67], and the adjusted odds ratio was 2.46 (95 % CI: 1.07-5.63). Conclusions Our exploratory analysis of data from the LCI-FIND trial showed that LCI is useful in identifying neoplastic lesions, when used in ultraslim endoscopy.
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Affiliation(s)
- Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hokkaido, Japan
| | - Kenro Kawada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahisa Murao
- Division of Gastroenterology Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Hokkaido, Japan
| | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Shinichiro Hori
- Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | | | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiro Katada
- Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Shimoda
- Internal Medicine and Gastrointestinal Endoscopy, Saga University, Saga, Japan
| | | | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | | | - Momoko Tsuda
- Division of Endoscopy, Hokkaido University Hospital, Hokkaido, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Keita Mori
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Osaka, Japan
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Mazidimoradi A, Momenimovahed Z, Salehiniya H. Barriers and Facilitators Associated with Delays in the Diagnosis and Treatment of Gastric Cancer: a Systematic Review. J Gastrointest Cancer 2021; 53:782-796. [PMID: 34499307 DOI: 10.1007/s12029-021-00673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The present study was conducted to identify barriers and facilitators of early diagnosis and treatment of gastric cancer. METHODS Comprehensive search was conducted on 2021 in various databases, including Medline, Web of science, and Scopus. Keywords such as gastric cancer, screening programs, endoscopy, barriers, facilitators, and factor were used for the search, as single or in combination. Also a manual search was done in valid scientific journals to find related full-text articles. The search results were entered into the Endonote-X8 software, which automatically removes duplicate articles. Then, the title and the abstract and finally, the text of the articles were studied. Articles that addressed barriers and facilitators of early diagnosis and treatment of gastric cancer were included. RESULTS In according to the results of 22 included articles, delay time in the diagnosis and treatment of gastric cancer were high, and factors such as age, sex, race and ethnicity, economic and social status, access to diagnostic services, implementation of screening programs, type and accuracy of screening methods, use of insurance services, error in care services, and presence of gastrointestinal symptoms were considered to be contributing factors in this regard. CONCLUSIONS It seems that to reduce delay in the diagnosis and treatment of gastric cancer, factors such as implementing screening programs using acceptable methods with high sensitivity and accuracy with a high level of participation, increasing insurance coverage and reducing the share of people in payments, increasing people's access to diagnostic services, educating people about the symptoms and risks of gastric cancer, undertaking proper follow-up in patients and suspects cases identified in screening, as well as increasing patients' access to medical services through financial and insurance support are significantly important.
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Affiliation(s)
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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Kumar L, Kholmurodova F, Bull J, Bright T, Watson DI, Shenfine J. Comparison of oesophageal and gastric cancer in the evaluation of urgent endoscopy referral criteria. ANZ J Surg 2021; 91:1515-1520. [PMID: 34124837 DOI: 10.1111/ans.16984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of the study is to identify differences in epidemiology and clinical presentation between oesophageal and gastric cancer and to evaluate the sensitivity of the Australian urgent endoscopy referral guidelines. METHODS Design; Observational cohort study from February 2013 to October 2018. SETTING A single tertiary specialist oesophago-gastric cancer centre: Flinders Medical Centre, South Australia. PARTICIPANTS Patients with oesophageal and gastric cancer that had surgery with curative intent 61.9% oesophageal cancer, 38.1% gastric cancer. MAIN OUTCOME MEASURES Differences between oesophageal and gastric cancer in terms of demographical variables, first presenting symptoms and sensitivity of the Australian urgent endoscopy referral guidelines. RESULTS Oesophageal cancer presented at a median age of 64.4 years old, with a male: female ratio of 6:1, and dysphagia as the first presenting symptom in 61%. Gastric cancer presented at a median age of 69.5, with a 2:1 male: female ratio and predominantly non-specific symptoms-blood loss (36%), weight loss, nausea, and anorexia (21%) and epigastric pain (13%). The Australia urgent endoscopy referral guidelines had 76% sensitivity for oesophageal cancer detection compared with a 33% sensitivity for gastric cancer in this cohort. Delays from symptom onset to referral occurred for most patients with timeframes over four times the recommended 2-week timeframe. CONCLUSION There should be a separate urgent referral guideline for oesophageal and gastric cancer. These should include dysphagia for oesophageal cancer and blood loss (anaemia, haematemesis, melaena) for gastric cancer. Delays from symptom onset to referral indicate the need for further education of the public and general practitioners on symptoms warranting urgent referral.
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Affiliation(s)
- Liana Kumar
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Feruza Kholmurodova
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - Jeff Bull
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - David I Watson
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Jonathan Shenfine
- Upper Gastrointestinal Surgery Unit, Jersey General Hospital, Jersey, UK
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7
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Premedication with reformulated simethicone and sodium bicarbonate improves mucosal visibility during upper gastrointestinal endoscopy: a double-blind, multicenter, randomized controlled trial. BMC Gastroenterol 2021; 21:124. [PMID: 33736601 PMCID: PMC7977252 DOI: 10.1186/s12876-021-01623-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background The reformulated simethicone emulsion from Berlin Chemical AG might develop white flocculate precipitate covering the gastric mucosa when used before esophagogastroduodenoscopy (EGD). We aim to investigate whether combining the reformulated simethicone emulsion with 5% sodium bicarbonate solution could prevent the development of white precipitate and improve visibility during EGD. Methods Our clinical study involved 523 patients. They were randomly assigned to two groups. In Group A, patients received a warm solution containing 30 ml 5% sodium bicarbonate solution and 15 ml reformulated simethicone emulsion. In Group B, patients received 45 ml 40 °C lukewarm water. Visibility scores were recorded and analyzed. Flushes, volume of flush water, overall time taken for EGD and complications during or after the procedure were also recorded. Results We found that no white precipitate was observed during EGD in Group A. Moreover, visibility scores in Group A were significantly lower (P < 0.01). Patients in Group A had fewer flushes (P < 0.01) and smaller volume of flush water (P < 0.01). In addition, the overall time taken for the EGD procedure was significantly shorter in Group A (P < 0.01). The percentage of patients who had no adverse response was significantly higher in Group A than in Group B (P < 0.01). Conclusions Premedication with a mixed solution of 15 ml reformulated simethicone emulsion and 30 ml 5% sodium bicarbonate solution can prevent the development of white precipitate, substantially enhancing mucosal visibility safely. Trial registration: The registered name of the trial is “Efficacy of using premedication with reformulated simethicone emulsion during upper gastrointestinal endoscopy examination”. Its Current Controlled Trials number is ChiCTR1900021689. Its date of registration is 11 September 2019. Retrospectively registered, http://www.medresman.org.cn/uc/sindex.aspx. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01623-w.
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Clinical Features of False-Negative Early Gastric Cancers: A Retrospective Study of Endoscopic Submucosal Dissection Cases. Gastroenterol Res Pract 2021; 2021:6635704. [PMID: 33628225 PMCID: PMC7886521 DOI: 10.1155/2021/6635704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background We frequently encounter early gastric cancer (EGC) that could not be detected in the previous esophagogastroduodenoscopy even if the procedure was annually performed. However, little evidence exists regarding the characteristics of false-negative EGCs. Our aim was to reveal the clinical features of false-negative EGCs. Methods We retrospectively reviewed cases of endoscopic submucosal dissection (ESD) for EGCs in Fukuchiyama City Hospital between January 2013 and May 2019. False-negative EGCs were defined as EGCs within 3 years of negative endoscopy. We evaluated the clinical characteristics of false-negative and initially detected EGCs and the difference in the detected and last missed endoscopy in false-negative EGCs. The miss rates of false-negative EGCs were compared between trainees (nonboard-certified endoscopists) and experienced endoscopists (board-certified endoscopists); thereafter, the characteristics of false-negative EGCs missed by trainees were investigated. Results Of 219 cases, 119 were classified as false-negative EGCs. False-negative EGCs were characterized as smaller lesions, which presented with normal color or gastritis-like appearance, and were diagnosed after ESD and H. pylori eradication (P < 0.01). The rate of trainees in the last missed endoscopy was significantly higher than that in the detected endoscopy. The miss rate of false-negative EGC by trainees was higher than that of experienced endoscopists but not significantly different (0.70% vs. 0.57%, P = 0.08). The false-negative EGCs missed by trainees were characterized as reddish or well-differentiated lesions, which were located in the lower or lesser curvature of the stomach (P < 0.05). Conclusion The characteristics of false-negative EGCs were similar to those of H. pylori-eradicated EGC. Procedures with shortened examination time and those performed by trainees were risk factors of missing false-negative EGCs. Trainees should pay attention to reddish or well-differentiated EGCs located in the lower or lesser curvature of the stomach.
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9
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Ikenoyama Y, Hirasawa T, Ishioka M, Namikawa K, Yoshimizu S, Horiuchi Y, Ishiyama A, Yoshio T, Tsuchida T, Takeuchi Y, Shichijo S, Katayama N, Fujisaki J, Tada T. Detecting early gastric cancer: Comparison between the diagnostic ability of convolutional neural networks and endoscopists. Dig Endosc 2021; 33:141-150. [PMID: 32282110 PMCID: PMC7818187 DOI: 10.1111/den.13688] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Detecting early gastric cancer is difficult, and it may even be overlooked by experienced endoscopists. Recently, artificial intelligence based on deep learning through convolutional neural networks (CNNs) has enabled significant advancements in the field of gastroenterology. However, it remains unclear whether a CNN can outperform endoscopists. In this study, we evaluated whether the performance of a CNN in detecting early gastric cancer is better than that of endoscopists. METHODS The CNN was constructed using 13,584 endoscopic images from 2639 lesions of gastric cancer. Subsequently, its diagnostic ability was compared to that of 67 endoscopists using an independent test dataset (2940 images from 140 cases). RESULTS The average diagnostic time for analyzing 2940 test endoscopic images by the CNN and endoscopists were 45.5 ± 1.8 s and 173.0 ± 66.0 min, respectively. The sensitivity, specificity, and positive and negative predictive values for the CNN were 58.4%, 87.3%, 26.0%, and 96.5%, respectively. These values for the 67 endoscopists were 31.9%, 97.2%, 46.2%, and 94.9%, respectively. The CNN had a significantly higher sensitivity than the endoscopists (by 26.5%; 95% confidence interval, 14.9-32.5%). CONCLUSION The CNN detected more early gastric cancer cases in a shorter time than the endoscopists. The CNN needs further training to achieve higher diagnostic accuracy. However, a diagnostic support tool for gastric cancer using a CNN will be realized in the near future.
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Affiliation(s)
- Yohei Ikenoyama
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan,Department of Hematology and OncologyMie University Graduate School of MedicineMieJapan
| | - Toshiaki Hirasawa
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan,Tada Tomohiro Institute of Gastroenterology and ProctologySaitamaJapan
| | - Mitsuaki Ishioka
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Ken Namikawa
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Shoichi Yoshimizu
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Yusuke Horiuchi
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Akiyoshi Ishiyama
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Toshiyuki Yoshio
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan,Tada Tomohiro Institute of Gastroenterology and ProctologySaitamaJapan
| | - Tomohiro Tsuchida
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Yoshinori Takeuchi
- Department of BiostatisticsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Satoki Shichijo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Naoyuki Katayama
- Department of Hematology and OncologyMie University Graduate School of MedicineMieJapan
| | - Junko Fujisaki
- Department of GastroenterologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Tomohiro Tada
- AI Medical Service IncTokyoJapan,Tada Tomohiro Institute of Gastroenterology and ProctologySaitamaJapan
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10
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Ono S, Kawada K, Dohi O, Kitamura S, Koike T, Hori S, Kanzaki H, Murao T, Yagi N, Sasaki F, Hashiguchi K, Oka S, Katada K, Shimoda R, Mizukami K, Suehiro M, Takeuchi T, Katsuki S, Tsuda M, Naito Y, Kawano T, Haruma K, Ishikawa H, Mori K, Kato M. Linked Color Imaging Focused on Neoplasm Detection in the Upper Gastrointestinal Tract : A Randomized Trial. Ann Intern Med 2021; 174:18-24. [PMID: 33076693 DOI: 10.7326/m19-2561] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Linked color imaging (LCI) is a new image-enhanced endoscopy technique that allows users to recognize slight differences in mucosal color. OBJECTIVE To compare the performance of LCI with white light imaging (WLI) in detecting neoplastic lesions in the upper gastrointestinal tract. DESIGN A controlled, multicenter trial with randomization using minimization. (University Hospital Medical Information Network Clinical Trials Registry: UMIN000023863). SETTING 16 university hospitals and 3 tertiary care hospitals in Japan. PATIENTS 1502 patients with known previous or current cancer of the gastrointestinal tract and undergoing surveillance for gastrointestinal cancer. INTERVENTION WLI followed by LCI examination (WLI group) or LCI followed by WLI examination (LCI group). MEASUREMENTS Diagnosis of 1 or more neoplastic lesions in the pharynx, esophagus, or stomach in the first examination (primary outcome) and 1 or more neoplastic lesions overlooked in the first examination (secondary outcome). RESULTS 752 patients were assigned to the WLI group and 750 to the LCI group. The percentage of patients with 1 or more neoplastic lesions diagnosed in the first examination was higher with LCI than with WLI (60 of 750 patients or 8.0% [95% CI, 6.2% to 10.2%] vs. 36 of 752 patients or 4.8% [CI, 3.4% to 6.6%]; risk ratio, 1.67 [CI, 1.12 to 2.50; P = 0.011]). The proportion with overlooked neoplasms was lower in the LCI group than in the WLI group (5 of 750 patients or 0.67% [CI, 0.2% to 1.6%] vs. 26 of 752 patients or 3.5% [CI, 2.3% to 5.0%]; risk ratio, 0.19 [CI, 0.07 to 0.50]). LIMITATION Endoscopists were not blinded. CONCLUSION LCI is more effective than WLI for detecting neoplastic lesions in the pharynx, esophagus, and stomach. PRIMARY FUNDING SOURCE Fujifilm Corporation.
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Affiliation(s)
- Shoko Ono
- Hokkaido University Hospital, Sapporo, Japan (S.O., M.T.)
| | - Kenro Kawada
- Tokyo Medical and Dental University, Tokyo, Japan (K.K.)
| | - Osamu Dohi
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan (O.D., Y.N.)
| | - Shinji Kitamura
- Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan (S.K.)
| | - Tomoyuki Koike
- Tohoku University Graduate School of Medicine, Sendai, Japan (T.K.)
| | - Shinichiro Hori
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan (S.H.)
| | - Hiromitsu Kanzaki
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan (H.K.)
| | | | | | - Fumisato Sasaki
- Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (F.S.)
| | | | - Shiro Oka
- Hiroshima University Hospital, Hiroshima, Japan (S.O.)
| | - Kazuhiro Katada
- North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K.)
| | | | | | - Mitsuhiko Suehiro
- Kawasaki Medical School General Medical Center, Okayama, Japan (M.S., K.H.)
| | | | | | - Momoko Tsuda
- Hokkaido University Hospital, Sapporo, Japan (S.O., M.T.)
| | - Yuji Naito
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan (O.D., Y.N.)
| | | | - Ken Haruma
- Kawasaki Medical School General Medical Center, Okayama, Japan (M.S., K.H.)
| | - Hideki Ishikawa
- Kyoto Prefectural University of Medicine, Osaka, Japan (H.I.)
| | - Keita Mori
- Shizuoka Cancer Center, Shizuoka, Japan (K.M.)
| | - Mototsugu Kato
- National Hospital Organization Hakodate National Hospital, Hakodate, Japan (M.K.)
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11
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Survival outcomes and rate of missed upper gastrointestinal cancers at routine endoscopy: a single centre retrospective cohort study. Eur J Gastroenterol Hepatol 2020; 32:1312-1321. [PMID: 32858661 DOI: 10.1097/meg.0000000000001863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Data on the long-term survival outcome of patients with missed upper gastrointestinal cancers (MUGC) is lacking. Retrospective studies have found no difference in 1- and 2-year survival among patients with missed gastric and oesophageal cancers; we thus aimed to assess 3-year survival of patients with MUGC at oesophagogastroduodenoscopy. METHODS This was a retrospective cohort study conducted at a single tertiary endoscopy centre. All oesophagogastroduodenoscopies performed between January 2007 and December 2015 were included in the study. The endoscopy database was cross-matched with the Slovenian Cancer Registry database. Missed cancers were defined as those diagnosed within 36 months after a negative oesophagogastroduodenoscopy. RESULTS During the study period, 29 617 oesophagogastroduodenoscopies were performed. In total, 422 upper gastrointestinal cancers were diagnosed and the rate of missed gastric cancers was 7.3% (95% CI, 4.9-10.6%) (26/354), and 4.4% (95% CI, 0.9-12.4%) for oesophageal cancers (3/68). Three-year survival of patients with MUGC was shorter than that of those with non-MUGC, being 12% (95% CI, 1-25%) vs. 31% (95% CI, 26-36%) (P = 0.043) for gastric and 0 vs. 9% (95% CI, 1-17%) (P = 0.121) for oesophageal cancer. CONCLUSION Missed gastric cancer during oesophagogastroduodenoscopy may be associated with shorter 3-year survival compared to patients whose gastric cancer was diagnosed at index oesophagogastroduodenoscopy.
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12
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Delgado-Guillena P, Morales-Alvarado V, Ramírez Salazar C, Jimeno Ramiro M, Llibre Nieto G, Galvez-Olortegui J, Uchima H. Frequency and clinical characteristics of early gastric cancer in comparison to advanced gastric cancer in a health area of Spain. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:506-514. [PMID: 32826088 DOI: 10.1016/j.gastrohep.2020.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Gastric cancer (GC) incidence is currently decreasing; however, survival is still low. Early GC (EGC) has better prognosis and it could be cured by endoscopic methods. PATIENTS AND METHODS Observational study of a retrospective cohort of all patients with GC during a five-year period in a health area of Spain. EGC diagnosis was defined as mucosal or submucosal (T1) cancers regardless of lymph node involvement, whereas the advanced GC were T2-T4. RESULTS 209 patients were included, and 26 (12%) of them were EGC. There was no difference between EGC and advanced GC in age, sex, HP infection, precancerous lesions or histological type. Other characteristics of EGC were different from advanced GC: location (antrum and incisura in 76% vs 38%, p=0.01), alarm symptoms (69% vs 90%, p<0.01), curative treatment (100% vs 30%, p<0.01), performance status (PS 0-1: 92% vs 75%, p=0.03) and survival (85% vs 20%, p<0.001). Among patients who received curative treatment, 98% (79/81) underwent surgery and 2% (2/81) were treated by mucosectomy. Seven (27%) patients with EGC could have benefited from treatment by endoscopic submucosal resection. DISCUSSION EGC frequency was low (12% of GCs) in our health area. EGC had a high percentage of alarm symptoms, and was located in the distal third of the stomach (antrum and incisura) and had better prognosis compared to advanced GC. Strategies to increase detection and endoscopic treatment of EGC should be implemented.
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Affiliation(s)
- Pedro Delgado-Guillena
- Unidad de Aparato Digestivo, Hospital General de Granollers, Barcelona, España; Universitat de Barcelona, Barcelona, España.
| | | | | | - Mireya Jimeno Ramiro
- Unidad de Anatomía Patológica, Hospital General de Granollers, Barcelona, España
| | - Gemma Llibre Nieto
- Unidad de Aparato Digestivo, Hospital General de Granollers, Barcelona, España
| | - Jose Galvez-Olortegui
- Unidad Generadora de Evidencias y Vigilancia Epidemiológica, Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Vicerrectorado de Investigación, Universidad Nacional Santiago Antúnez de Mayolo, Huaraz, Perú
| | - Hugo Uchima
- Hospital Germans Trias i Pujol, Badalona, España
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13
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Delgado Guillena PG, Morales Alvarado VJ, Jimeno Ramiro M, Rigau Cañardo J, Ramírez Salazar C, García Rodríguez A, Córdova Guevara H, Fernández Esparrach G. Gastric cancer missed at esophagogastroduodenoscopy in a well-defined Spanish population. Dig Liver Dis 2019; 51:1123-1129. [PMID: 30967337 DOI: 10.1016/j.dld.2019.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although esophagogastroduodenoscopy (EGD) is the standard procedure for the diagnosis of gastric cancer (GC), some GCs are missed. There are no published data on the missed rate of GC in Spain. AIMS To determine the frequency and characteristics of missed GCs and assess the quality of the EGD in a specific population with GC. METHODS Records of all patients diagnosed with gastric adenocarcinoma between 2012 and 2016 in a defined geographic area were reviewed. Missed GC was defined as a case with a prior negative EGD for cancer. Quality indicators from the prior EGDs were measured. RESULTS From 212 cases of GC, 25 cases were excluded. Seventeen out of 187 patients had a prior EGD (9.1%). Twelve of those 17 missed GC had a prior EGD with some abnormal findings. In 6 of them, biopsies were taken. Survival was no different between patients with missed and non-missed GC. Quality indicators that failed to meet standards were recording time, image documentation, and a protocol of biopsies. CONCLUSIONS Missed GC in an EGD in a defined population in Spain is not uncommon (9.1%). The endoscopist is an important factor in missed GC due to lack of adequate detection and sampling error. Compliance with performance of quality indicators could reduce missed GC.
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Affiliation(s)
- Pedro Genaro Delgado Guillena
- Department of Gastroenterology, Hospital General de Granollers, Barcelona, Spain; Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru.
| | | | | | | | | | | | - Henry Córdova Guevara
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gloria Fernández Esparrach
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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14
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Yan H, Li M, Cao L, Chen H, Lai H, Guan Q, Chen H, Zhou W, Zheng B, Guo Z, Zheng C. A robust qualitative transcriptional signature for the correct pathological diagnosis of gastric cancer. J Transl Med 2019; 17:63. [PMID: 30819200 PMCID: PMC6394047 DOI: 10.1186/s12967-019-1816-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/21/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Currently, pathological examination of gastroscopy biopsy specimens is the gold standard for gastric cancer (GC) diagnosis. However, it has a false-negative rate of 10-20% due to inaccurate sampling locations and/or insufficient sampling amount. A signature should be developed to aid the early diagnosis of GC using biopsy specimens even when they are sampled from inaccurate locations. METHODS We extracted a robust qualitative transcriptional signature, based on the within-sample relative expression orderings (REOs) of gene pairs, to discriminate both GC tissues and adjacent-normal tissues from non-GC gastritis, intestinal metaplasia and normal gastric tissues. RESULTS A signature consisting of two gene pairs for GC diagnosis was identified and validated in data of both biopsy specimens and surgical resection specimens pooled from publicly available datasets measured by different laboratories with different platforms. For gastroscopy biopsy specimens, 96.20% of 79 non-GC tissues were correctly identified as non-GC, and 96.84% of 158 GC tissues and six of seven adjacent-normal tissues were correctly identified as GC. For surgical resection specimens, 98.37% of 2560 GC tissues and 97.28% of 221 adjacent-normal tissues were correctly identified as GC. Especially, 97.67% of the 257 GC patients at stage I were exactly diagnosed as GC. We additionally measured 21 GC tissues from seven different GC patients, each with three specimens sampled from three tumor locations with different proportions of the tumor epithelial cell. All these GC tissues were correctly identified as GC, even when the proportion of the tumor epithelial cell was as low as 14%. CONCLUSIONS The qualitative transcriptional signature can distinguish both GC and adjacent-normal tissues from normal, gastritis and intestinal metaplasia tissues of non-GC patients even using inaccurately sampled biopsy specimens, which can be applied robustly at the individual level to aid the early GC diagnosis.
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Affiliation(s)
- Haidan Yan
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, China
| | - Meifeng Li
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, China
| | - Longlong Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China
| | - Haifeng Chen
- Department of General Surgery, Fuzhou Second Hospital Affiliated To Xiamen University, Xiamen, 350007, China
| | - Hungming Lai
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, China
| | - Qingzhou Guan
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, China
| | - Huxing Chen
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, China
| | - Wenbin Zhou
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China
| | - Baotong Zheng
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, China
| | - Zheng Guo
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, China. .,Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150086, China.
| | - Chaohui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, China.
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15
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Dohi O, Yagi N, Naito Y, Fukui A, Gen Y, Iwai N, Ueda T, Yoshida N, Kamada K, Uchiyama K, Takagi T, Konishi H, Yanagisawa A, Itoh Y. Blue laser imaging-bright improves the real-time detection rate of early gastric cancer: a randomized controlled study. Gastrointest Endosc 2019; 89:47-57. [PMID: 30189197 DOI: 10.1016/j.gie.2018.08.049] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Blue laser imaging-bright (BLI-bright) has shown promise as a more useful tool for detection of early gastric cancer (EGC) than white-light imaging (WLI). However, the diagnostic performance of BLI-bright in the detection of EGC has not been investigated. We aimed to compare real-time detection rates of WLI with that of BLI-bright for EGC. METHODS This was a prospective, randomized, controlled study in 2 Japanese academic centers. We investigated 629 patients undergoing follow-up endoscopy for atrophic gastritis with intestinal metaplasia or surveillance after endoscopic resection of EGC. Patients were randomly assigned to receive primary WLI followed by BLI-bright or primary BLI-bright followed by WLI. The real-time detection rates of EGC were compared between primary WLI and primary BLI-bright. RESULTS There were 298 patients in each group. The real-time detection rate of EGC with primary BLI-bright was significantly greater than that with primary WLI (93.1% vs 50.0%; P = .001). Primary BLI-bright had a significantly greater ability to detect EGCs in patients with a history of endoscopic resection for EGC, no Helicobacter pylori infection in the stomach after eradication therapy, lesions with an open-type atrophic border, lesions in the lower third of the stomach, depressed-type lesions, small lesions measuring <10 mm and 10 to 20 mm in diameter, reddish lesions, well-differentiated adenocarcinomas, and lesions with a depth of invasion of T1a. CONCLUSIONS BLI-bright has a higher real-time detection rate for EGC than WLI. BLI-bright should be performed during surveillance endoscopy in patients at high risk for EGC. (Clinical trial registration number: UMIN000011324.).
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Affiliation(s)
- Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuaki Yagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akifumi Fukui
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuyuki Gen
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoto Iwai
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohiro Ueda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akio Yanagisawa
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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16
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He M, Jiang Z, Wang C, Hao Z, An J, Shen J. Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis. J Surg Oncol 2018; 118:1243-1256. [DOI: 10.1002/jso.25285] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/05/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Meifeng He
- Chengde Medical UniversityChengde Hebei China
| | - Zhanwu Jiang
- Baoding First Central HospitalBaoding Hebei China
| | | | - Zhiwei Hao
- Baoding First Central HospitalBaoding Hebei China
| | - Jie An
- Baoding First Central HospitalBaoding Hebei China
| | - Jiankai Shen
- Baoding First Central HospitalBaoding Hebei China
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17
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Smith CF, Tompson AC, Jones N, Brewin J, Spencer EA, Bankhead CR, Hobbs FR, Nicholson BD. Direct access cancer testing in primary care: a systematic review of use and clinical outcomes. Br J Gen Pract 2018; 68:e594-e603. [PMID: 30104328 PMCID: PMC6104856 DOI: 10.3399/bjgp18x698561] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/04/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Direct access (DA) testing allows GPs to refer patients for investigation without consulting a specialist. The aim is to reduce waiting time for investigations and unnecessary appointments, enabling treatment to begin without delay. AIM To establish the proportion of patients diagnosed with cancer and other diseases through DA testing, time to diagnosis, and suitability of DA investigations. DESIGN AND SETTING Systematic review assessing the effectiveness of GP DA testing in adults. METHOD MEDLINE, Embase, and the Cochrane Library were searched. Where possible, study data were pooled and analysed quantitatively. Where this was not possible, the data are presented narratively. RESULTS The authors identified 60 papers that met pre-specified inclusion criteria. Most studies were carried out in the UK and were judged to be of poor quality. The authors found no significant difference in the pooled cancer conversion rate between GP DA referrals and patients who first consulted a specialist for any test, except gastroscopy. There were also no significant differences in the proportions of patients receiving any non-cancer diagnosis. Referrals for testing were deemed appropriate in 66.4% of those coming from GPs, and in 80.9% of those from consultants; this difference was not significant. The time from referral to testing was significantly shorter for patients referred for DA tests. Patient and GP satisfaction with DA testing was consistently high. CONCLUSION GP DA testing performs as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction.
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Affiliation(s)
| | - Alice C Tompson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Nicholas Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Josh Brewin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Elizabeth A Spencer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Clare R Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
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Monrroy H, Vargas JI, Glasinovic E, Candia R, Azúa E, Gálvez C, Rojas C, Cabrera N, Vidaurre J, Álvarez N, González J, Espino A, González R, Parra-Blanco A. Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy: a double-blind, randomized controlled trial. Gastrointest Endosc 2018; 87:986-993. [PMID: 29037773 DOI: 10.1016/j.gie.2017.10.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/01/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Upper GI endoscopy (UGE) is essential for the diagnosis of gastrointestinal diseases. Mucus and bubbles may decrease mucosal visibility. The use of mucolytics could improve visualization. Our aim was to determine whether premedication with simethicone or simethicone plus N-acetylcysteine is effective in improving visibility during UGE. METHODS This was a randomized, double-blinded, placebo-controlled trial with 2 control groups: no intervention and water 100 mL (W); and 3 intervention groups: simethicone 200 mg (S); S + N-acetylcysteine (NAC) 500 mg (S+NAC500); and S + NAC 1000 mg (S+NAC1000). The solution was ingested 20 minutes before UGE. Gastric visibility was evaluated in 4 segments with a previously described scale. A score of less than 7 points was defined as adequate visibility (AV). Water volume was used to improve visibility, and adverse reactions were evaluated as a secondary outcome. Multiple group comparison was performed using non-parametric one-way analysis of variance (ANOVA). RESULTS Two hundred thirty patients were included in the study, 68% female, mean age 49 years. The most common indication for UGE was epigastric pain/dyspepsia (33%). AV was more frequent in the S+NAC500 and S+NAC1000 groups (65% and 67%) compared with no intervention (44%, P = .044) and water (41%, P = .022). The gastric total visibility scale (TVS) was significantly better in the S+NAC500 and S+NAC1000 groups compared with water (P = .03 and P = .008). Simethicone was not different from no intervention and water. S+NAC1000 required less water volume to improve visibility. No adverse reactions from the study drugs were observed. CONCLUSIONS Premedication with S+NAC500 and S+NAC1000 improves visibility during UGE. The use of simethicone did not show improvements in gastric visibility. TVS was worse in patients using water alone. (Clinical trial registration number: NCT 01653171.).
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Affiliation(s)
- Hugo Monrroy
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Jose Ignacio Vargas
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | | | - Roberto Candia
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Emilio Azúa
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Gálvez
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Rojas
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Cabrera
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Josefa Vidaurre
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Álvarez
- Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Jessica González
- Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Alberto Espino
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Robinson González
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Adolfo Parra-Blanco
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, United Kingdom
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Parker C, Alexandridis E, Plevris J, O'Hara J, Panter S. Transnasal endoscopy: no gagging no panic! Frontline Gastroenterol 2016; 7:246-256. [PMID: 28839865 PMCID: PMC5369487 DOI: 10.1136/flgastro-2015-100589] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications. METHODS A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature. RESULTS There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORD-associated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes. CONCLUSIONS TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.
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Affiliation(s)
- Clare Parker
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK
| | | | - John Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - James O'Hara
- Department of Otolaryngology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Panter
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, Newcastle upon Tyne, UK
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20
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Missing rate for gastric cancer during upper gastrointestinal endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016; 28:1041-9. [PMID: 27148773 DOI: 10.1097/meg.0000000000000657] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Esophagogastroduodenoscopy (EGD) is considered a very effective method to identify gastric cancer (GC). However, the existence of missed lesions has been frequently discussed. This systematic review and meta-analysis aimed at assessing the magnitude of missing GC diagnosis with EGD and its predictive factors. METHODS MEDLINE was searched to identify all studies assessing and reporting the proportion of missed GC diagnosis with EGD. Pooled proportion and negative predictive values were computed using the random-effects model and heterogeneity was assessed using the Cochrane Q-test and I. RESULTS The studies included (n=22) were grouped by study design. The pooled negative predictive value was 99.7% (95% confidence interval 99.6-99.9%). Missed GCs proportion was 9.4% (95% confidence interval 5.7-13.1%), being 10.0% in studies including patients with negative EGD followed over time, 8.3% in studies including patients with GC, and 23.3% in studies evaluating the proportion of missed synchronous lesions. Mainly, missed cancers were located in the gastric body both in Eastern and in Western studies (39 and 47%, respectively). The majority of missed GCs were adenocarcinomas. Younger age (<55 years), female sex, marked gastric atrophy, gastric adenoma or ulcer, and inadequate number of biopsy fragments were reported as predictive factors for diagnostic failure. CONCLUSION EGD is a very effective method to rule out GC. However, missing GC with EGD is not uncommon, with one out of 10 cancers being potentially missed. Interestingly, lesions were more often missed in the body and therefore a more rigorous protocol for endoscopy and biopsy should be implemented worldwide.
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21
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Chapelle N, Bouvier AM, Manfredi S, Drouillard A, Lepage C, Faivre J, Jooste V. Early Gastric Cancer: Trends in Incidence, Management, and Survival in a Well-Defined French Population. Ann Surg Oncol 2016; 23:3677-3683. [PMID: 27216743 DOI: 10.1245/s10434-016-5279-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Little is known about the epidemiology of early gastric cancer (EGC) in Western countries. The aim of this study was to analyze trends in the incidence, management, and survival of EGC in a well-defined population over a 30 year period. METHODS Data were obtained from the population-based cancer Registry of Burgundy (France). Incidence rates were calculated by sex, age, and 10 year period of diagnosis. Net survival rates were calculated and a multivariate relative survival analysis performed. RESULTS EGC represented 6.7 % of gastric cancer diagnosed between 1982 and 2011. Age-standardized incidence rates were higher in men (0.79/100,000) than in women (0.40/100,000). Between the periods 1982-1991 and 2002-2011, it decreased from 0.97 to 0.53 per 100,000 in men and from 0.44 to 0.30 per 100,000 in women. Overall, 19 % of the tumors were limited to the mucosa, 69 % to the submucosa, and 15 % invaded lymph nodes. Node invasion and male sex were the only significant prognostic factors. Five-year net survival was 50 % in node-positive patients and 85 % in node-negative patients (p < 0.001). In multivariate analysis, the relative risk of death in men compared to women was 2.3 and was 10.4 in patients with positive nodes compared to patients with negative nodes. CONCLUSIONS EGCs are rare in France. The prognosis is favorable, except for node-positive cancers, which may benefit from the recently developed adjuvant chemotherapy for gastric cancer.
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Affiliation(s)
- Nicolas Chapelle
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Anne-Marie Bouvier
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Sylvain Manfredi
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Antoine Drouillard
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Come Lepage
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Jean Faivre
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France.,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France.,CHU Dijon Bourgogne, Dijon, France
| | - Valerie Jooste
- Registre Bourguignon des Cancers Digestifs, INSERM, LNC UMR866, Dijon, France. .,Université Bourgogne Franche-Comté, LNC UMR866, Dijon, France. .,CHU Dijon Bourgogne, Dijon, France.
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23
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Gastric Cancers Missed During Endoscopy in England. Clin Gastroenterol Hepatol 2015; 13:1264-1270.e1. [PMID: 25645877 DOI: 10.1016/j.cgh.2015.01.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/13/2015] [Accepted: 01/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Single-center studies have estimated that 4.6% to 25.8% of gastric cancers are missed at endoscopy. We performed a population-based study to make a more precise estimate of factors associated with missed lesions in England. METHODS We performed a retrospective population-based observational cohort study of 2727 patients diagnosed with gastric cancer from April 2011 through March 2012 in England, using linked records from 3 national data sets. The primary outcome was the proportion of patients who had undergone endoscopy in the 3 to 36 months before a diagnosis of gastric cancer. We determined this proportion for the entire cohort and for subgroups. RESULTS Of the 2727 patients in the cohort, 8.3% (95% confidence interval, 7.2%-9.3%) underwent endoscopic evaluation in the 3 to 36 months before their diagnosis of gastric cancer. An endoscopy within 3 to 36 months of diagnosis was associated with a diagnosis of early stage cancer (stages 0 or 1, 11.5%; stage 2, 7.9%; stages 3 or 4, 6.9%; P = .01 for stage 0 or 1 vs stage 2 or greater), younger age at diagnosis (<55 y, 13.3% vs ≥55 y, 7.8%; P = .03), and female sex (10% of women vs 7.3% of men; P = .01). Gastric ulcers were detected in 15% of endoscopies performed at any time in the 3 years before cancer diagnosis, and in 64% of endoscopies performed 3 to 6 months before a diagnosis of gastric cancer. CONCLUSIONS Based on a retrospective analysis of medical records in England, in 8.3% of patients with gastric cancer, their cancer was missed at endoscopy within the 3 previous years. A previous endoscopy detected benign gastric ulcers more frequently than any other lesion in patients who later were diagnosed with gastric cancer.
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24
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Zhang Q, Chen ZY, Chen CD, Liu T, Tang XW, Ren YT, Huang SL, Cui XB, An SL, Xiao B, Bai Y, Liu SD, Jiang B, Zhi FC, Gong W. Training in early gastric cancer diagnosis improves the detection rate of early gastric cancer: an observational study in China. Medicine (Baltimore) 2015; 94:e384. [PMID: 25590840 PMCID: PMC4602560 DOI: 10.1097/md.0000000000000384] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Few studies have analyzed the training of endoscopists in the diagnosis of early gastric cancer (EGC). This study assessed whether specific training of endoscopists improves the detection rate of EGC. The rates of detection of EGC by endoscopists at the Digestive Endoscopy Center of the Affiliated Nanfang Hospital of China Southern Medical University between January 2013 and May 2014 were retrospectively analyzed. Because some endoscopists received training in the diagnosis of EGC, beginning in September 2013, the study was divided into 3 time periods: January to September 2013 (period 1), September 2013 to January 2014 (period 2), and January to May 2014 (period 3). The rates of EGC detection during these 3 periods were analyzed. From January 2013 to May 2014, a total of 25,314 gastroscopy examinations were performed at our center, with 48 of these examinations (0.2%) detecting EGCs, accounting for 12.1% (48/396) of the total number of gastric cancers detected. The EGC detection rates by trained endoscopists during periods 1, 2, and 3 were 0.3%, 0.6%, and 1.5%, respectively, accounting for 22.0%, 39.0%, and 60.0%, respectively, of the gastric cancers detected during these time periods. In comparison, the EGC detection rates by untrained endoscopists during periods 1, 2, and 3 were 0.05%, 0.08%, and 0.10%, respectively, accounting for 3.1%, 6.0%, and 5.7%, respectively, of the gastric cancers detected during these times. After training, the detection rate by some trained endoscopists markedly increased from 0.2% during period 1 to 2.3% during period 3. Further, the use of magnifying endoscopy with narrow-band imaging (M-NBI) (odds ratio = 3.1, 95% confidence interval 2.4-4.1, P < 0.001) contributed to the diagnosis of EGC. In conclusion, specific training could improve the endoscopic detection rate of EGC. M-NBI contributed to the diagnosis of EGC.
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Affiliation(s)
- Qiang Zhang
- From the Department of Gastroenterology (QZ, Z-yC, C-dC, TL, X-wT, Y-tR, S-lH, X-bC, BX, YB, S-dL, BJ, F-cZ, WG), Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province; and Department of Bio-Statistics (S-lA), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
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Menon S, Trudgill N. How commonly is upper gastrointestinal cancer missed at endoscopy? A meta-analysis. Endosc Int Open 2014; 2:E46-50. [PMID: 26135259 PMCID: PMC4476431 DOI: 10.1055/s-0034-1365524] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/17/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Upper gastrointestinal (UGI) cancer in the Western world usually presents at an advanced stage, when opportunities for curative therapy are limited. The failure to detect subtle, early-stage UGI cancer at endoscopy may contribute to a poor prognosis. We undertook a meta-analysis of studies of endoscopic miss rates for UGI cancer to quantify how often opportunities to diagnose cancer at an earlier stage are missed. PATIENTS AND METHODS A MEDLINE search was conducted to identify relevant studies, and a meta-analysis was conducted. "Missed" UGI cancer was defined as cancer that had not been diagnosed by UGI endoscopy performed within 3 years before the diagnosis. Random effects meta-analysis was used to determine the event rate of missed UGI cancer. RESULTS Ten studies were identified that included 3,787 patients with UGI cancer. Four hundred eighty-seven UGI cancers were missed at endoscopy within 3 years before diagnosis. Marked heterogeneity was observed between studies (I (2), 94.4 %; P < 0.001). On random effects meta-analysis, the pooled miss rates were 6.4 % (95 % confidence interval [CI], 4.3 % - 9.5 %) within 1 year and 11.3 % (95 % CI, 7.5 % - 16.6 %) within 3 years before diagnosis. There appeared to be no difference between the miss rates of oesophageal (44 %) and gastric (51 %) cancer (P = 0.42). Conclusion It appears that 11.3 % of UGI cancers are missed at endoscopy up to 3 years before diagnosis. To ameliorate the poor prognosis of patients with UGI cancer in the Western world, efforts should be made to improve the quality of UGI endoscopy and create opportunities for earlier diagnosis.
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Affiliation(s)
- Shyam Menon
- Department of Gastroenterology, The Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wolverhampton, United Kingdom,Corresponding author Shyam Menon Department of GastroenterologyThe Royal Wolverhampton Hospitals NHS TrustNew Cross HospitalWolverhampton WV6 8AYUnited Kingdom
| | - Nigel Trudgill
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, United Kingdom
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MARK's Quadrant scoring system: a symptom-based targeted screening tool for gastric cancer. Ann Gastroenterol 2014; 27:34-41. [PMID: 24714557 PMCID: PMC3959528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gastric cancer is notably one of the leading causes of cancer-related death in the world. In Malaysia, these patients present in the advanced stage, thus narrowing the treatment options and making the surgery nearly impossible for successful curative resection. Failure to identify high-risk patients and delay in diagnostic endoscope procedure contributed to the delay in diagnosis. The aim of the study was to develop and validate a scoring system (MARK's Quadrant) which can identify symptomatic patients who are at risk for gastric cancer. METHODS A 3-phase approach was undertaken: Phase 1: development of the weighted scoring system; Phase 2: estimating positive predicting value of MARK's Quadrant; and Phase 3: a) testing the validity of MARK's Quadrant in an open-access endoscope system; and b) comparing its usefulness compared to conventional referral system. RESULTS In phases 1 and 2, MARK's Quadrant with weighted symptoms was developed. The sensitivity of MARK's Quadrant is 88% and the specificity is 45.5% to detect cancerous and precancerous lesions of gastric. This was confirmed by the prospective data from phase 3 of this study where the diagnostic yield of MARK's Quadrant to detect any pathological lesion was 95.2%. This score has a high accuracy efficiency of 75%, hence comparing to routine referral system it has an odds ratio (95%CI) of 10.98 (4.63-26.00), 6.71 (4.46-10.09) and 0.95 (0.06-0.15) (P<0.001 respectively) for cancer, precancerous lesion and benign lesion diagnosis respectively. CONCLUSION MARK's Quadrant is a useful tool to detect early gastric cancer among symptomatic patients in a low incidence region.
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Abstract
PURPOSE The proposed guideline for performing endoscopic resection of early gastric carcinoma (EGC) in Paris classification is a well-differentiated carcinoma with maximum involvement Sm1. Signet ring cell carcinomas (SRC) are excluded from this recommendation. Authors from Eastern countries have proposed extending this resection to include selected undifferentiated EGC. Via an analysis of a series of cases of signet ring carcinoma, we will discuss whether it is possible to resect EGC with signet ring cells in Europe. METHODS We retrospectively included patients with histological classification pT1 of EGC showing SRC. Data was extracted from the hospital gastrectomy register. Lymphadenomectomy D1.5 was performed on all patients. Histology results were retrospectively obtained from the electronic patient file. RESULTS Twelve patients (mean age = 55.4, four women, eight men) underwent surgery, without previous chemotherapy, between 2000 and 2012, for EGC with SRC. Mean size of the lesions was 20.2 mm (5-35 mm). Seven lesions were located in the antrum, five in the fundus. In the case of nine patients, histology showed no lymphovascular involvement. None of these nine patients presented lymph node metastases (LNM). Five patients had intramucosal carcinoma, four were classified as Sm1, one patient was Sm2, and one patient was Sm3. On surgery, the three patients with lymphovascular invasion showed LNM. CONCLUSION Endoscopic resection of EGC with SRC does not systematically imply complementary treatment by surgery, although criteria for endoscopic resection are difficult to determine because of the lack of data in Europe.
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Abstract
Given its morbidity and mortality, the early detection and diagnosis of gastric cancer is an area of intense research focus. This article reviews the emerging use of enhanced endoscopic imaging technologies in the detection and management of gastric cancer. The combined use of white-light endoscopy with enhanced imaging technologies, such as magnification narrow-band imaging, chromoendoscopy, and autofluorescence endoscopy, demonstrates promise in the improved ability to detect and delineate gastric neoplasia. However, widespread clinical use is still limited, mainly because of the restricted availability of the technologies.
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Affiliation(s)
- Susana Gonzalez
- Henry D. Janowitz Division of Gastroenterology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1069, New York, NY 10029, USA.
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Premedication with N-acetylcysteine and simethicone improves mucosal visualization during gastroscopy: a randomized, controlled, endoscopist-blinded study. Eur J Gastroenterol Hepatol 2013; 25:778-83. [PMID: 23739279 DOI: 10.1097/meg.0b013e32836076b2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Diagnostic gastroscopy provides a unique opportunity to diagnose early oesophagogastric neoplasia; however, intraluminal mucus and bile can obscure mucosal visualization. The aim of this study was to determine whether the use of a premedication solution containing the mucolytic agent N-acetylcysteine and the surfactant simethicone improves mucosal visualization within a UK diagnostic gastroscopy service. MATERIALS AND METHODS A total of 75 consecutive patients were recruited from a single (S.J.) endoscopist's diagnostic gastroscopy list. They were randomized into three treatment groups: (a) standard control=clear fluids only for 6 h, nil by mouth for 2 h; (b) water control=standard control+100 ml sterile water (given 20 min before gastroscopy); and (c) solution=standard control+100 ml investigated solution (20 min before gastroscopy). The endoscopist was blinded to patient preparation. Inadequate mucosal visualization was defined as fluid/mucus during gastroscopy that could not be suctioned and required flushing with water. The volume of flush, the site at which it was used and the total procedure times were recorded. RESULTS All three groups showed no statistical difference for age, sex ratio, procedure priority or indication. The mean volume of flush required to obtain clear mucosa was significantly less in the solution group compared with the other groups. The mean overall procedure time was also less in the solution group compared with the other groups. DISCUSSION Premedication with N-acetylcysteine and simethicone markedly improves mucosal visibility during gastroscopy. It also reduces the time taken for the procedure. This low-cost and well-tolerated intervention may improve detection of early neoplasia.
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Gisbert JP, Calvet X, Ferrándiz J, Mascort J, Alonso-Coello P, Marzo M. [Clinical practice guideline on the management of patients with dyspepsia. Update 2012]. Aten Primaria 2012; 44:727.e1-727.e38. [PMID: 23036729 PMCID: PMC7025630 DOI: 10.1016/j.aprim.2012.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 05/30/2012] [Indexed: 12/13/2022] Open
Abstract
The aim of the Clinical Practice Guideline (CPG) on the Management of Patients with Dyspepsia is to generate recommendations on the optimal approach to dyspepsia in the primary care and specialized outpatient setting. The main objective of this CPG is to help to optimize the diagnostic process, identifying patients with a low risk of a serious organic disease (mainly tumoral), who could be safely managed without the need for invasive diagnostic tests and/or referral to a specialist. The importance of this aim lies in the need to accurately diagnose patients with esophagogastric cancer and correctly treat peptic ulcer while, at the same time, reduce negative endoscopies in order to appropriately use the available healthcare resources. This CPG reviews the initial strategies that can be used in patients with uninvestigated dyspepsia and evaluates the possible decision to begin empirical therapy or to investigate the existence of a lesion that could explain the symptoms. This CPG also discusses functional dyspepsia, which encompasses all patients with dyspepsia with no demonstrable cause on endoscopy. Recommendations for the diagnosis and treatment of peptic ulcer and Helicobacter pylori infection are also made. To classify the scientific evidence and strengthen the recommendations, the GRADE (Grading of Recommendations Assessment, Development and Evaluation Working Group) system has been used (http://www.gradeworkinggroup.org/).
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Affiliation(s)
- Javier P. Gisbert
- Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España
| | - Xavier Calvet
- Corporació Universitària Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España
| | - Juan Ferrándiz
- Subdireccion de Calidad, Dirección General de Atención al Paciente, Servicio Madrileño de Salud, Madrid, España
| | - Juan Mascort
- CAP Florida Sud, Institut Català de la Salut, Departament de Ciències Clíniques, Campus Bellvitge, Facultat de Medicina, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, España
| | - Pablo Alonso-Coello
- Centro Cochrane Iberoamericano, Instituto de Investigaciones Biomédicas (IIB Sant Pau) Barcelona, España
| | - Mercè Marzo
- Unitat de suport a la recerca – IDIAP Jordi Gol, Direcció d’Atenció Primària Costa De Ponent, Institut Català de la Salut, Barcelona, España
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[Clinical practice guideline on the management of patients with dyspepsia. Update 2012]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012. [PMID: 23186826 DOI: 10.1016/j.gastrohep.2012.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of the Clinical Practice Guideline (CPG) on the Management of Patients with Dyspepsia is to generate recommendations on the optimal approach to dyspepsia in the primary care and specialized outpatient setting. The main objective of this CPG is to help to optimize the diagnostic process, identifying patients with a low risk of a serious organic disease (mainly tumoral), who could be safely managed without the need for invasive diagnostic tests and/or referral to a specialist. The importance of this aim lies in the need to accurately diagnose patients with esophagogastric cancer and correctly treat peptic ulcer while, at the same time, reduce negative endoscopies in order to appropriately use the available healthcare resources.This CPG reviews the initial strategies that can be used in patients with uninvestigated dyspepsia and evaluates the possible decision to begin empirical therapy or to investigate the existence of a lesion that could explain the symptoms. This CPG also discusses functional dyspepsia, which encompasses all patients with dyspepsia with no demonstrable cause on endoscopy. Recommendations for the diagnosis and treatment of peptic ulcer and Helicobacter pylori infection are also made. To classify the scientific evidence and strengthen the recommendations, the GRADE (Grading of Recommendations Assessment, Development and Evaluation Working Group) system has been used (http://www.gradeworkinggroup.org/).
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Osawa H, Yamamoto H, Miura Y, Ajibe H, Shinhata H, Yoshizawa M, Sunada K, Toma S, Satoh K, Sugano K. Diagnosis of depressed-type early gastric cancer using small-caliber endoscopy with flexible spectral imaging color enhancement. Dig Endosc 2012; 24:231-6. [PMID: 22725107 DOI: 10.1111/j.1443-1661.2011.01224.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Small-caliber endoscopy has lower resolution than normal-caliber endoscopy, limiting its use in routine outpatient practice. Flexible spectral imaging color enhancement (FICE) strengthens the color contrast of depressed-type early gastric cancer without magnification. The aim of the present study was to evaluate the detection of depressed-type early gastric cancer using small-caliber endoscopy with the FICE system. METHODS Eighty-two patients diagnosed with depressed-type early gastric cancer by standard endoscopy and biopsy were evaluated by small-caliber endoscopy. FICE images and conventional images were compared. Color differences in all 82 lesions were measured between malignant lesions and the surrounding mucosa using the Commission Internationale de L'Eclairage (CIE) 1976 color space. RESULTS Most cancers were readily detected as reddish lesions on FICE images. Lines of demarcation between the malignant lesion and the surrounding mucosa were easily identified with FICE images, as such cancers could be clearly distinguished from the surrounding atrophic mucosa. Greater median color differences between malignant lesions and the surrounding mucosa were present in FICE images compared with conventional images, resulting in images with better contrast (27.2 vs 18.7, P<0.0001). CONCLUSIONS Small-caliber endoscopy with the FICE system provides better color contrast of depressed-type early gastric cancers than conventional small-caliber endoscopy, and the FICE system may facilitate the diagnosis of this type of cancer as a new endoscopic modality.
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Affiliation(s)
- Hiroyuki Osawa
- Department of Internal Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
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Huppertz-Hauss G, Chengarov L, Dahler S, Jørgensen A, Moritz V, Paulsen J, Hoff G. "Drop in" gastroscopy outpatient clinic--experience after 9 months. BMC Gastroenterol 2012; 12:12. [PMID: 22297144 PMCID: PMC3293713 DOI: 10.1186/1471-230x-12-12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 02/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Logistics handling referrals for gastroscopy may be more time consuming than the examination itself. For the patient, "drop in" gastroscopy may reduce uncertainty, inadequate therapy and time off work. METHODS After an 8-9 month run-in period we asked patients, hospital staff and GPs to fill in a questionnaire to evaluate their experience with "drop in" gastroscopy and gastroscopy by appointment, respectively. The diagnostic gain was evaluated. RESULTS 112 patients had "drop in" gastroscopy and 101 gastroscopy by appointment. The number of "drop in" patients varied between 3 and 12 per day (mean 6.5). Mean time from first GP consultation to gastroscopy was 3.6 weeks in the "drop in" group and 14 weeks in the appointment group. The half-yearly number of outpatient gastroscopies increased from 696 before introducing "drop in" to 1022 after (47% increase) and the proportion of examinations with pathological findings increased from 42% to 58%. Patients and GPs expressed great satisfaction with "drop in". Hospital staff also acclaimed although it caused more unpredictable working days with no additional staff. CONCLUSIONS "Drop in" gastroscopy was introduced without increase in staff. The observed increase in gastroscopies was paralleled by a similar increase in pathological findings without any apparent disadvantages for other groups of patients. This should legitimise "drop in" outpatient gastroscopies, but it requires meticulous observation of possible unwanted effects when implemented.
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Affiliation(s)
- Gert Huppertz-Hauss
- Department of Gastroenterology, Medical Clinic, Telemark Hospital, 3710 Skien, Norway.
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Asl SMKH, Sivandzadeh GR. Efficacy of premedication with activated Dimethicone or N-acetylcysteine in improving visibility during upper endoscopy. World J Gastroenterol 2011; 17:4213-7. [PMID: 22072853 PMCID: PMC3208366 DOI: 10.3748/wjg.v17.i37.4213] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 01/18/2011] [Accepted: 01/25/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficacy of N-acetylcysteine (NAC) and activated Dimethicone in improving endoscopic mucosal visibility.
METHODS: A total of 148 patients were randomly allocated into four groups to receive one of the following premedications: group A: 100 mL water alone; group B: activated Dimethicone plus water (up to 100 mL); group C: NAC plus water (up to 100 mL); and group D: activated Dimethicone and NAC plus water (up to 100 mL). A single endoscopist blinded to the patients group assessed the gastric mucosal visibility scores (range 1-4) at four sites. The sum of the scores from the four sites was considered as the total mucosal visibility score (TMVS).
RESULTS: The patients in group B showed a significantly lower TMVS than those of groups A and C (P < 0.001). The TMVS in patients of group D was significantly lower than that of groups A and C (P < 0.001). The TMVS did not significantly differ between groups B and D (P > 0.05). The difference between TMVS of groups C and A was not significant (P > 0.05).
CONCLUSION: Premedication with activated Dimethicone 20 min prior to the upper endoscopy leads to the best visibility. NAC does not improve visualization by itself.
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Osime OC, Momoh MI, Irowa OO, Obumse A. Gastric carcinoma--a big challenge in a poor economy. J Gastrointest Cancer 2010; 41:101-6. [PMID: 20052563 DOI: 10.1007/s12029-009-9118-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastric carcinoma is usually characterized with significant morbidity and mortality mainly because of late presentation. Late presentation of gastric carcinoma is a prominent feature in developing and poor countries. AIM OF STUDY The purpose of this study is to present our experience with the pattern and outcome of gastric tumors at the University of Benin Teaching Hospital, Benin City, Nigeria; with emphasis on late presentation of the patients. PATIENTS AND METHODS The case files of the patients that were managed at the University of Benin Teaching Hospital for gastric tumors over a 5-year period (January 2004 to December 2006) were analyzed for biodata, symptoms and signs of disease, findings at operation, treatment offered, and outcome of treatment. RESULTS The male/female ratio was 2.3:1, with the youngest patient being 38 years while the oldest patient was 76 years old. Upper abdominal pain and a palpable mass per abdomen were the commonest symptoms and signs, respectively. Alcohol ingestion was the commonest identifiable risk factor. Only 30.4% of the patients presented within a year of the onset of symptoms. The gastric antrum was affected in over 78% of the cases, and adenocarcinoma was found in about 90% of the patients. Partial gastrectomy with gastrojejunostomy was the commonest procedure carried out. The mortality rate was 39.1%, and of the patients that died, 66.7% occurred within a year from time of diagnosis. CONCLUSION Most of the cases of gastric carcinoma presented in this study presented late with associated significant mortality. Health education is advised with a view to encouraging early presentation.
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Affiliation(s)
- O Clement Osime
- Department of Surgery, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria.
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Prompt upper endoscopy is an appropriate initial management in uninvestigated chinese patients with typical reflux symptoms. Am J Gastroenterol 2010; 105:1947-52. [PMID: 20354508 DOI: 10.1038/ajg.2010.121] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We sought to investigate the prevalence of clinically significant endoscopic findings (CSEFs) in Chinese patients presenting with uninvestigated typical reflux symptoms in the absence of alarm symptoms, and to evaluate whether prompt endoscopy is an appropriate initial management in these patients. METHODS Consecutive patients presenting with uninvestigated typical reflux symptoms (i.e., heartburn or acid regurgitation) as chief complaints were recruited for symptom evaluation and upper endoscopy, followed by a 2-week proton pump inhibitor (PPI) therapy. RESULTS Of 469 patients recruited, CSEFs were observed in 180 (38.4%): 154 (32.8%) with erosive esophagitis (EE), 18 (3.8%) with Barrett's esophagus (BE), 24 (5.1%) with peptic ulcer disease (PUD), and 4 (0.9%) with carcinomas (1 esophageal carcinoma and 3 gastric adenocarcinomas). Multivariate analysis identified that an age >50 years (odds ratio (OR)=1.94, P=0.008), male gender (OR=4.11, P<0.001), being overweight or obese (OR=2.99, P<0.001), and alcohol use (OR=9.96, P<0.001) were independent risk factors for EE; an age >50 years (OR=4.61, P=0.003) and alcohol use (OR=5.50, P=0.003) were independent risk factors for BE; and Helicobacter pylori infection (OR=8.52, P<0.001) and alcohol use (OR=4.08, P=0.004) were independent risk factors for PUD. Symptom evaluation and response to PPI treatment were not correlated with EE, BE, and PUD in these patients. CONCLUSIONS CSEFs other than gastroesophageal reflux disease are present in a considerable proportion of Chinese patients with uninvestigated typical reflux symptoms but without alarm features. Symptom evaluation is of limited practical value, and thus prompt endoscopy seems to be an appropriate initial management option in these patients.
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Im JP, Kim SG, Kim JS, Jung HC, Song IS. Time-dependent morphologic change in depressed-type early gastric cancer. Surg Endosc 2009; 23:2509-14. [PMID: 19296170 DOI: 10.1007/s00464-009-0434-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2008] [Revised: 02/13/2009] [Accepted: 02/27/2009] [Indexed: 12/29/2022]
Abstract
BACKGROUND Depressed-type early gastric cancer (EGC) is known to repeat improvement and exacerbation of ulceration during its natural course, forming a "malignant cycle." However, it is difficult to observe the malignant cycle of EGC in clinical practice, and little is known about the clinicopathologic factors associated with this cycle. This study aimed to evaluate the malignant cycle of EGC and to determine the clinicopathologic factors associated with the time-dependent morphologic change of EGC. METHODS The medical records of EGC patients treated at the Seoul National University Hospital were retrospectively reviewed with two or more comparable endoscopic photos taken between March 1999 and December 2005. The ulcer stages in EGC were classified by the gastric ulcer stage system and evaluated for time-dependent morphologic changes according to the relevant factors. RESULTS In this study, 231 cases of depressed-type EGC were evaluated. At the follow-up endoscopy after a median interval of 23 days, a change in ulcer stage was observed in 66 patients (29%), with improvement in 45 patients (20%) and exacerbation in 21 patients (9%). Of the 177 patients who demonstrated an active or healing stage, 45 (25%) showed improvement and 10 (6%) exhibited exacerbation. The multivariate analysis showed that the usage of antisecretory medications, mucosal cancer, and a longer interval between the two endoscopic examinations were the factors that had a significant association with improvement of the ulcer stage. CONCLUSIONS The malignant cycle was frequently observed in depressed-type EGC. The improvement of ulceration in EGC was time dependent and associated with the usage of antisecretory medication and the depth of invasion.
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Affiliation(s)
- Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-799, Korea
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Diagnosis of elevated-type early gastric cancers by the optimal band imaging system. Gastrointest Endosc 2009; 69:19-28. [PMID: 19111685 DOI: 10.1016/j.gie.2008.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 09/05/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND The endoscopic diagnosis of an elevated-type early gastric cancer is often difficult. The optimal band imaging (OBI) system can reconstruct the best spectral images decomposed from ordinary endoscopic images with free selection of 3 wavelengths and provide unmagnified images with high light intensity as well as magnified images. OBJECTIVE To evaluate whether the OBI system facilitates detection of the demarcation lines between an elevated-type early gastric cancer and surrounding tissue and thus is more helpful for performing endoscopic therapy. DESIGN A prospective study. SETTING Jichi Medical University, Japan. PATIENTS Seventy-five patients, 81 lesions with an elevated-type early gastric cancer. MAIN OUTCOME MEASUREMENTS A comparison between OBI images and conventional endoscopic images in the identification of the demarcation lines of an elevated-type early gastric cancer without magnification and the rate of success in identifying the abnormal surface structure of cancer by using low-magnified OBI images. RESULTS Demarcation lines were easily identified in OBI images, even without magnification, because such cancers could be clearly distinguished from the surrounding whitish atrophic mucosa. Inexperienced endoscopists could determine demarcation lines with significantly greater accuracy with unmagnified OBI images than with conventional images. With 40-fold magnification, irregular microstructural or nonstructural patterns were also found within cancer lesions in all cases studied but in none of the cases in the surrounding noncancerous mucosa. CONCLUSIONS The new contrast images obtained with the OBI system enable better determination of the demarcation lines of elevated-type early gastric cancers, and this system may be useful for performing endoscopic therapy of this type of cancer as a new endoscopic modality.
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Axon A. Is diagnostic and therapeutic endoscopy currently appropriate?: suggestions for improvement. Best Pract Res Clin Gastroenterol 2008; 22:959-70. [PMID: 18790441 DOI: 10.1016/j.bpg.2008.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Endoscopy is the driving force in gastroenterology today, and recent exciting advances in technology have extended its frontiers at an unprecedented rate. We have a wider range of diagnostic and therapeutic possibilities at our disposal with more detailed methods available to analyse what we see on our video screens. We can access the small bowel lumen with consistency and intra-abdominal operations have been performed through the mouth and anus so where are the current limitations of the procedure? In spite of these remarkable advances many challenges remain for both the endoscopist and for industry, they are mainly ones associated with human weakness. Endoscopy is an art, performed by individuals who require training and continued education and it is done to patients who are vulnerable, afraid and often seriously unwell. It is human aspects of endoscopy that require improvement. This chapter addresses the areas where endoscopy is falling short and suggests what can be done to improve practice. Changes are needed in management, information technology, education, team working, quality, patient comfort and safety. There also remain a number of areas where improved technology may be able to reduce human error.
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Affiliation(s)
- Anthony Axon
- Department of Gastroenterology, Room 234 D Floor Clarendon Wing, The General Infirmary at Leeds, Great George Street, Leeds, LS1 3EX, UK.
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Osawa H, Yoshizawa M, Yamamoto H, Kita H, Satoh K, Ohnishi H, Nakano H, Wada M, Arashiro M, Tsukui M, Ido K, Sugano K. Optimal band imaging system can facilitate detection of changes in depressed-type early gastric cancer. Gastrointest Endosc 2008; 67:226-34. [PMID: 18061596 DOI: 10.1016/j.gie.2007.06.067] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 06/30/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND The endoscopic diagnosis of depressed-type early gastric cancers is difficult because these cancers manifest as subtle changes in color and shape. The newly developed optimal band imaging (OBI) system can reconstruct the best spectral images derived from ordinary endoscopic images and enhances the mucosal surface without the use of dyes. This imaging technique is based on narrowing the bandwidth of conventional image arithmetically by using spectral estimation technology. OBJECTIVE Evaluation of the usefulness of the OBI system for identifying the demarcation line of depressed-type early gastric cancers. DESIGN Prospective study. SETTING Jichi Medical University in Japan. PATIENTS Twenty-seven cases with depressed-type early gastric cancer. MAIN OUTCOME MEASUREMENT Comparative study for the success rate of identifying the demarcation line of depressed-type early gastric cancer by using optimal band images and conventional endoscopic images. RESULTS Demarcation of the depressed-type early gastric cancer was easily identified by optimal band images without magnification in 26 of 27 cases (96%), because distinct demarcation was observed endoscopically between the reddish images of the cancerous lesion and the yellowish images of the surrounding noncancerous area. With 40-fold magnification of optimal band images, the demarcation was also clearly recognized in all cases. Medical students could point out the demarcation line with significantly greater accuracy by observing the new nonmagnified optimal band images than by the conventional images (P< .0001). LIMITATION Small sample size. CONCLUSIONS The new contrasting images of the OBI system can delineate the depressed-type early gastric cancer more easily than conventional endoscopy.
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Affiliation(s)
- Hiroyuki Osawa
- Department of Internal Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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DaCosta RS, Wilson BC, Marcon NE. Recent Advances in Light‐Induced Fluorescence Endoscopy (LIFE) of the Gastrointestinal Tract. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1999.tb00206.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Ralph S. DaCosta
- *Department of Medical Biophysics, University of Toronto/Ontario Cancer Institute. Toronto, Canada
| | - Brian C. Wilson
- *Department of Medical Biophysics, University of Toronto/Ontario Cancer Institute. Toronto, Canada
| | - Norman E. Marcon
- **Division of Gastroenterology, The Wellesley Central Site, St. Michael's Hospital, Toronto, Canada
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McColl K. CON: Endoscopy is not necessary before treating Helicobacter pylori in patients with uncomplicated dyspepsia. Am J Gastroenterol 2007; 102:474-6. [PMID: 17335440 DOI: 10.1111/j.1572-0241.2007.01088_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Chang CC, Chen SH, Lin CP, Hsieh CR, Lou HY, Suk FM, Pan S, Wu MS, Chen JN, Chen YF. Premedication with pronase or N-acetylcysteine improves visibility during gastroendoscopy: An endoscopist-blinded, prospective, randomized study. World J Gastroenterol 2007; 13:444-7. [PMID: 17230616 PMCID: PMC4065902 DOI: 10.3748/wjg.v13.i3.444] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficacy of premedicaton with pronase or N-acetylcysteine (NAC) at 20 min before upper gastrointestinal (UGI) endoscopy and to determine whether pronase or NAC pretreatment influences the reliability of the rapid urease test.
METHODS: A total of 146 patients were prospectively and randomly assigned into the study groups according to different premedications before endoscopy. One endoscopist assessed mucosal visibility (MV) with scores ranged from 1 to 4 at four sites in the stomach. The sum of the MV scores from these four locations was defined as the total mucosal visibility (TMV) score. Identification of H pylori was performed using CLO test, histology, and serology.
RESULTS: The Group with pronase premedication had a significantly lower TMV score than did the groups with gascon and gascon water (p < 0.001 and p < 0.01, respectively). The group with NAC had a significantly lower TMV score than the group with gascon (p < 0.01) and a trend of a lower MV score than the group with gascon water (p = 0.06). The TMV score did not significantly differ between the group with pronase and the group with NAC (p = 0.39 and p = 0.14, respectively). The sensitivity and specificity of the CLO test were 92.5% and 93.9%, respectively, in groups premedicated with pronase and NAC together.
CONCLUSION: Premedication with pronase or NAC at 20 min before UGI endoscopy improves the mucosal visibility of the stomach. Neither pronase nor NAC produces any obvious interference with the CLO test for the identification of H pylori infection.
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Affiliation(s)
- Chun-Chao Chang
- Division of Gastroenterology, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan, China.
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Katai H, Sano T. Early gastric cancer: concepts, diagnosis, and management. Int J Clin Oncol 2006; 10:375-83. [PMID: 16369740 DOI: 10.1007/s10147-005-0534-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Indexed: 12/16/2022]
Affiliation(s)
- Hitoshi Katai
- Department of Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Abstract
The prognosis of gastric cancer is closely related to the stage of disease at diagnosis. Early gastric cancer, whereby disease is limited to mucosa and submucosa, confers a survival rate of greater than 90% in 5 years in many centres. Gastric cancer is still a major cause of cancer mortality worldwide. In high incidence areas such as Japan, screening of asymptomatic population has been advocated. However, in Western countries, mass screening is not cost-effective. Hence, strategy has been directed to screen symptomatic individuals who are at higher risk of gastric cancer. Most patients with early gastric cancer present with symptoms indistinguishable from benign peptic ulcer disease. Screening for this group of patients improves detection rate of early gastric cancer and therefore its prognosis. Endoscopy for surveillance of premalignant lesions has been explored with this objective in mind. Serology testing for biomarkers such as pepsinogen, anti-Helicobacter pylori antibody and gastrin has been studied as an alternative to endoscopy. There is compelling evidence for the role of H. pylori in the initiation of Correa's cascade (stepwise progression from chronic active gastritis, atrophic gastritis, intestinal metaplasia, dysplasia and finally adenocarcinoma). Regression of premalignant lesions has been demonstrated with H. pylori eradication. However, it is not known whether this might effectively prevent gastric cancer in either low or high-risk population.
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Affiliation(s)
- Yih K Tan
- Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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Casburn-Jones AC, Murray LS, Gillen D, McColl KEL. Endoscopy has minimal impact on mortality from upper gastrointestinal cancer in patients older than 55 years with uncomplicated dyspepsia. Eur J Gastroenterol Hepatol 2006; 18:645-8. [PMID: 16702854 DOI: 10.1097/00042737-200606000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION The objective of the study was to determine the effectiveness of endoscopy to detect curable upper gastrointestinal malignancy in patients older than 55 years presenting with uncomplicated dyspepsia. METHODS A cohort study was performed in North Glasgow Health Trust. One hundred and thirty-one patients older than 55 years of age, diagnosed to have upper gastrointestinal cancer within the North Glasgow Trust between January 1995 and December 1997, identified by the West of Scotland Cancer Registry were included. The main outcome measures were the proportion of upper gastrointestinal cancers that present in patients older than 55 years with uncomplicated dyspepsia, and the proportion of patients that presented with uncomplicated dyspepsia who have curable upper gastrointestinal cancer. RESULTS Of the 131 cancer cases identified, only 30 (23%) had dyspepsia (complicated or uncomplicated) as their predominant symptom and only eight (6%) patients presented with uncomplicated dyspepsia. Of those eight patients presenting with uncomplicated dyspepsia and found to have upper gastrointestinal cancer, six were found to have lymph node metastases and/or extensive metastases at the time of diagnosis. Each of these six patients died from their cancer within 39 months of diagnosis. Of the two patients presenting with uncomplicated dyspepsia without evidence of lymph node spread, one died 55 days after diagnosis. Only one patient presenting with uncomplicated dyspepsia and found to have cancer remains alive at 5-year follow-up. CONCLUSIONS Of the 131 patients diagnosed with upper gastrointestinal cancer, only eight presented with uncomplicated dyspepsia and only one of these was cured. Consequently a policy of endoscoping patients older than 55 years with uncomplicated dyspepsia will reduce death from upper gastrointestinal cancers by less than 1% in our population.
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Affiliation(s)
- Anna C Casburn-Jones
- Division of Cardiovascular & Medical Sciences, Section of Internal Medicine, Endocrinology and Metabolism, Western Infirmary, Glasgow, UK
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Abstract
Five-year survival of gastric cancer is 10% in Western countries compared with over 50% in Japan. This is because the disease is not identified in the West until later in its evolution. T1 cancer has an excellent prognosis, but most of the patients either have no symptoms or complain of long-standing, non-specific dyspepsia; alarm symptoms, when identified, usually indicate that the cancer is already inoperable. Early gastric cancer is infrequently diagnosed in the West because the low prevalence of gastric cancer means that endoscopists do not search with the same diligence as they do in Japan. A further barrier is the widespread prescription of proton pump inhibitors that heal malignant ulcers and diminish symptoms, thus rendering them more difficult to identify clinically and endoscopically. An improvement in diagnosis may be achieved by newer endoscopy technology which enables cancers to be identified more easily, or by an inexpensive screening test to select patients with extensive gastric atrophy, thereby identifying those at risk who can then be screened endoscopically.
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Affiliation(s)
- Anthony Axon
- Department of Gastroenterology, The General Infirmary at Leeds, Leeds, UK.
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Voutilainen ME, Juhola MT. Evaluation of the diagnostic accuracy of gastroscopy to detect gastric tumours: clinicopathological features and prognosis of patients with gastric cancer missed on endoscopy. Eur J Gastroenterol Hepatol 2005; 17:1345-9. [PMID: 16292088 DOI: 10.1097/00042737-200512000-00013] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Some gastric cancers are missed during diagnostic gastroscopy, but data are sparse on the clinical characteristics of patients with missed gastric cancers and on the accuracy of gastroscopy for detecting these tumours. We evaluated the number, clinicopathological characteristics, and survival of patients with missed gastric cancers, and the sensitivity and specificity of gastroscopy to detect these tumours. METHODS Data on gastric cancers detected in 1996-2001 in a single hospital referral area were obtained from the National Cancer Registry. Patient files were examined to identify those who underwent gastroscopy less than 3.5 years before a cancer diagnosis. RESULTS Of the 284 gastric cancer patients, 13 (4.6%) had undergone gastroscopy in the previous 3.5 years; their mean age was 72.4 years at the time of the first gastroscopy. The median delay in cancer diagnosis was 11.5 months. Histologically, all patients had gastric carcinoma. The sensitivity and specificity of gastroscopy for diagnosing gastric cancer were 0.93 and 1.00, respectively. Among the deceased patients, no difference was observed in the survival of cases with non-missed (n = 191) and missed (n = 10) carcinoma: 9.4 versus 7.3 months (P = 0.15). CONCLUSION A small proportion of gastric carcinomas are missed on gastroscopy, causing a significant delay in diagnosis. However, the prognoses of patients with missed and non-missed gastric carcinoma were equally poor.
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Lassen A, Hallas J, de Muckadell OBS. The risk of missed gastroesophageal cancer diagnoses in users and nonusers of antisecretory medication. Gastroenterology 2005; 129:1179-86. [PMID: 16230072 DOI: 10.1053/j.gastro.2005.07.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 06/30/2005] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Some patients with early gastroesophageal cancer may appear to "heal" because of antisecretory medication, but the risk of a missed diagnosis is unknown. The aim of the study was to estimate the incidence of gastroesophageal cancer with or without pre-endoscopic treatment with antisecretory medication. METHODS We extracted data on use of endoscopies, gastroesophageal cancer diagnoses, death, migration, and use of antisecretory medication (H(2) blockers and proton pump inhibitors) from 5 population-based registries covering 1974-2002. We included all citizens in Funen County (population, 470,000) who between 1993 and 2002 were investigated by endoscopy for the first time. The patients were followed up until death, emigration, or the end of the study period. RESULTS Among 27,829 patients with a first endoscopy (mean age, 56 years; 48% male, 115,804 person-years of follow-up), 461 had gastroesophageal cancer diagnosed at the first endoscopy and 52 were diagnosed during a median follow-up of 2.7 years after the first endoscopy. The incidence during follow-up was similar to the background population (standardized incidence ratio, 1.24; 95% confidence interval, 0.81-1.91), increased with age, and was higher in male patients. The incidence of gastroesophageal cancer during follow-up was 46 per 100,000 person-years in users of antisecretory medication the last 180 days before the first endoscopy compared with 44 per 100,000 person-years in nonusers (age and sex standardized difference, 4 per 100,000 person-years; 95% confidence interval, -14 to 22). CONCLUSIONS Very few cancers are missed at endoscopy. The risk seems similar in users and nonusers of antisecretory medication before endoscopy.
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Affiliation(s)
- Annmarie Lassen
- Department of Medical Gastroenterology, Odense University Hospital, Denmark.
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