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Kim HY. Clinical features of gastric adenoma detected within 3 years after negative screening endoscopy in Korea. Gastroenterol Rep (Oxf) 2023; 11:goad039. [PMID: 37408567 PMCID: PMC10318390 DOI: 10.1093/gastro/goad039] [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: 09/26/2022] [Revised: 04/20/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
Background Early detection and management of gastric adenoma are important for preventing gastric cancer. The present study aimed to evaluate the predictors of missed gastric adenoma on screening endoscopy in Korea and identify the risk factors associated with interval precancerous gastric lesions. Methods All cases of gastric adenomas diagnosed via screening endoscopy between 2007 and 2019 were reviewed. Among them, those who had undergone endoscopy within 3 years were included in the present study. Missed gastric adenoma was defined as gastric adenoma diagnosed within 3 years after negative screening endoscopy. Results In total, 295 cases of gastric adenoma were identified. Of these, 95 (32.2%) were missed gastric adenoma cases (mean age, 60.6 years; average interval between final and index endoscopies, 12.6 months); the remaining 200 (67.8%) were newly detected adenoma cases. Univariate analysis revealed that male sex, endoscopist experience, observation time, and presence of gastric intestinal metaplasia (pathologically proven) were associated with missed gastric adenoma. Multivariate analysis revealed that gastric intestinal metaplasia (odds ratio [OR], 2.736; 95% confidence interval [CI], 1.320-5.667; P = 0.007) and shorter observation time of the index screening endoscopy (B, -0.011; OR, 0.990; 95% CI, 0.986-0.993; P < 0.001) were independent risk factors for missed gastric adenoma. The optimal cut-off for the observation time for detecting gastric adenoma was 3.53 minutes (area under curve, 0.738; 95% CI, 0.677-0.799; P < 0.001). Conclusions Gastric intestinal metaplasia is an indication of missed gastric adenoma. Therefore, careful inspection of gastric mucosa with gastric intestinal metaplasia and proper observation time can lower the possibility of missing the gastric adenoma during screening.
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Affiliation(s)
- Hyun Young Kim
- Corresponding author. Department of Internal Medicine, Health Promotion Center, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620 South Korea. Tel: + 82-31-787-7008; Fax: + 82-31-787-4051;
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2
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Pang L, Yan X, Su D, Wu X, Jiang H. Feasibility of olfactomedin 4 as a molecular biomarker for early diagnosis of gastric neoplasia after intestinal metaplasia. Scand J Gastroenterol 2023; 58:133-141. [PMID: 36124708 DOI: 10.1080/00365521.2022.2116992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study discusses whether olfactomedin 4 (OLFM4) could be used as a sensitive and specific biomarker in the early diagnosis of gastric cancer (GC) after gastric intestinal metaplasia (GIM). METHODS An integrative analysis combining data derived from the Gene Expression Omnibus (GEO) and cBioPortal databases was performed to investigate the potential molecular biomarker. Immunohistochemistry and quantitative real-time polymerase chain reactions were used to measure the expression of messenger ribonucleic acid (mRNA) and protein by OLFM4. In combination with the gastroscopic findings and the OLFM4 expression in GIM-GC, a predictive model was established. The receiver operator characteristic curve (ROC) was applied to assess the diagnostic value of the model for GIM-GC. RESULTS According to the GEO and cBioPortal databases, OLFM4 was identified as a key gene in the diagnosis of GIM-GC. Higher protein expression of OLFM4 was found in GIM and GIM-GC compared with chronic superficial gastritis (GS) (p < 0.05). The positive expression rate of OLFM4 in paracancerous tissue (GCP) was higher than in GIM (p > 0.05). There was no significant difference between GIM-GC and GCP (p > 0.05). The mRNA expression of OLFM4 was similar to the protein expression, and the positive expression rate was higher in early GIM-GC than in GIM (p < 0.05). CONCLUSION Olfactomedin 4 could be used as a biomarker for the early diagnosis of GIM-GC, and the logistic predictive model could be an effective tool for increasing the early diagnostic rate.
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Affiliation(s)
- Lixing Pang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin Yan
- Department of Endocrinology, Nanning Second People's Hospital, Nanning, China
| | - Dongxing Su
- Department of Gastroenterology, Nanning Second People's Hospital, Nanning, China
| | - Xianbin Wu
- Department of Gastroenterology, Nanning Second People's Hospital, Nanning, China
| | - Haixing Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Unno S, Igarashi K, Saito H, Hirasawa D, Okuzono T, Tanaka Y, Nakahori M, Matsuda T. Assigning a different endoscopist for each annual follow-up may contribute to improved gastric cancer detection rates. Endosc Int Open 2022; 10:E1333-E1342. [PMID: 36262509 PMCID: PMC9576325 DOI: 10.1055/a-1922-6429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background and study aims Esophagogastroduodenoscopy (EGD) is an effective and important diagnostic tool to detect gastric cancer (GC). Although previous studies show that examiner, patient, and instrumental factors influence the detection of GC, we analyzed whether assigning a different examiner to surveillance EGD would improve the detection of GC compared to assigning the same examiner as in the previous endoscopy. Patients and methods We retrospectively reviewed patients who underwent two or more consecutive surveillance EGDs at a single center between 2017 and 2019. We identified factors associated with GC detection using multivariable regression analysis and propensity-score matching. Results Among 7794 patients, 99 GC lesions in 93 patients were detected by surveillance EGD (detection rate; 1.2 %), with a mean surveillance interval of 11.2 months. Among the detected 99 lesions, 87 (87.9 %) were curatively treated with endoscopy. There were no differences in the clinicopathologic characteristics of GC detected by the same or different endoscopists. GC detection in the group examined by different endoscopists was more statistically significant than in the group examined by the same endoscopist, even after propensity-score matching (1.6 % and 0.7 %; P < 0.05). Endoscopic experience and other factors were not statistically significant between the two groups. Conclusions In surveillance EGD, having a different endoscopist for each exam may improve GC detection rates, regardless of the endoscopist's experience.
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Affiliation(s)
- Shuhei Unno
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan,Department of Gastroenterology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Kimihiro Igarashi
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Dai Hirasawa
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Toru Okuzono
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Yukari Tanaka
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Masato Nakahori
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Tomoki Matsuda
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
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Kim TJ, Pyo JH, Byun YH, Choi SC, Hong JP, Min YW, Lee H, Min BH, Rhee PL, Kim JJ, Lee JH. Interval Advanced Gastric Cancer After Negative Endoscopy. Clin Gastroenterol Hepatol 2022; 21:1205-1213.e2. [PMID: 36075502 DOI: 10.1016/j.cgh.2022.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Esophagogastroduodenoscopy (EGD) is effective in reducing gastric cancer mortality through detection of early-stage cancer in areas with a high prevalence of gastric cancer. Although the risk of post-endoscopy advanced gastric cancer (AGC) is low, interval AGC remains a concern. We investigated the characteristics and predictors of interval AGC after negative EGD. METHODS We included 1257 patients with gastric cancer within 6 to 36 months of a "cancer-negative" index EGD between 2005 and 2021 at a tertiary university hospital in South Korea. Observation time on the index EGD was used as a quality indicator. We compared the clinical and endoscopic characteristics and quality indicators between interval AGC and screen-detected early gastric cancer (EGC). RESULTS Within 6 to 36 months of negative EGD, 102 AGCs (8.1%) and 1155 EGCs (91.9%) were identified. The percentage of patients with shorter observation time (<3 minutes) in the index EGD was higher in the interval AGC group than in the detected EGC group (P = .002). A multivariable analysis comparing screen-detected EGD and interval AGC was adjusted for age, sex, family history of gastric cancer, H. pylori status, endoscopic findings, and endoscopy-related factors including gastric observation time and interval time. A shorter observation time (<3 minutes) (odds ratio, 2.27; 95% confidence interval, 1.20-4.30), and interval time >2 years (odds ratio, 1.84; 95% confidence interval, 1.04-3.24) were associated with an increased risk of interval AGC. CONCLUSION A shorter observation time during index EGD is an important predictor of interval AGC. Further, withdrawal time longer than 3 minutes may be a quality indicator for screening EGD.
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Affiliation(s)
- Tae Jun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeung Hui Pyo
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Hye Byun
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Chul Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Pyo Hong
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Castaño-Llano R, Piñeres A, Jaramillo R, Molina S, Aristizábal F, Puerta JE. Interval gastric cancer: A call to attentiveness and action. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2022; 88:91-99. [PMID: 35659441 DOI: 10.1016/j.rgmxen.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND AIMS Endoscopy is the most effective method for identifying gastric adenocarcinoma (GAC). Interval gastric cancer (IGC) is GAC that is diagnosed 2-3 years after a normal endoscopy. Its characteristics are unknown in the Colombian environment. The clinical, histopathologic, and endoscopic characteristics were evaluated, along with the presentation rate, proton pump inhibitor (PPI) use, and IGC survival rate, and compared with other types of GAC. METHODS A retrospective, analytic study was conducted on a prospective cohort. It evaluated 513 patients with GAC treated at our institution, within the time frame of January 2012 and June 2018. The patients had endoscopic diagnosis of GAC and endoscopy within the past three years that was negative for tumor. RESULTS A total of 513 patients diagnosed with GAC were evaluated. Forty-two of the patients had IGC (8.2%): 9 early lesions and 33 advanced lesions (79%). The IGCs were smaller (31 vs. 41 mm; P < .01), as well as flatter and more depressed (P < .01). There was no association with PPI use, but there was an association with a history of gastrectomy and anastomosis (P = .02), as well as the absence of red flags (P < .003). The most frequent locations were the gastric body (52%) and the antrum (26%). Overall two-year survival was similar between IGC and GAC (37.1 vs. 39.3%, P = .72). CONCLUSION A total of 8.2% of recently diagnosed GAC were cases of IGC. The presence of anastomosis and the absence of red flags were related to IGC. Overall survival was poor and there were no differences from the other types of GAC detected.
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Affiliation(s)
- R Castaño-Llano
- Cirugía Gastrointestinal y Endoscopia Clínica las Américas, Medellín, Antioquía, Colombia; Grupo de Gastro-Hepatología, Universidad de Antioquia, Medellín, Antioquía, Colombia; Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia.
| | - A Piñeres
- Cirugía Gastrointestinal y Endoscopia Clínica las Américas, Medellín, Antioquía, Colombia; Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia
| | - R Jaramillo
- Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia; Clínica las Américas, Medellín, Antioquía, Colombia
| | - S Molina
- Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia; Clínica las Américas, Medellín, Antioquía, Colombia
| | - F Aristizábal
- Instituto de Cancerología, Clínica las Américas, Medellín, Antioquía, Colombia; Clínica las Américas, Medellín, Antioquía, Colombia
| | - J E Puerta
- Universidad CES, Medellín, Antioquía, Colombia
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Association of Regular Endoscopic Screening with Interval Gastric Cancer Incidence in the National Cancer Screening Program. J Clin Med 2021; 11:jcm11010230. [PMID: 35011973 PMCID: PMC8745904 DOI: 10.3390/jcm11010230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/31/2022] Open
Abstract
Although regular endoscopic screening may help in early detection of gastric cancer, interval cancer remains a problem in the screening program. This study evaluated the association between regular endoscopic screening and interval cancer detection in the Korean National Cancer Screening Program (KNCSP). We defined three groups (regularly, irregularly, and not screened) according to the screening interval, and the trends in the interval cancer rate (ICR) between the groups were tested using the Cochran-Armitage test. The influence of regular endoscopic screening on the risk of interval cancer was evaluated using multivariable logistic regression. Among the 11,642,410 participants who underwent endoscopy, the overall ICR was 0.36 per 1000 negative screenings. The ICR of the not screened group (0.41) was the highest among the three groups and the risk of interval cancer in this group was 1.68 times higher (p < 0.001) than that in the regularly screened group. Women in their 40s who had regular screening with no history of intestinal metaplasia and gastric polyps would have the lowest probability of having interval cancer (0.005%). Regular participation in endoscopic screening programs for reducing the risk of interval cancer may help to improve the quality of screening programs.
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Ishibashi F, Kobayashi K, Kawakami T, Tanaka R, Sugihara K, Baba S. Quality management system for screening esophagogastroduodenoscopy improves detection of Helicobacter pylori -negative interval gastric cancer. Endosc Int Open 2021; 9:E1900-E1908. [PMID: 34917459 PMCID: PMC8671005 DOI: 10.1055/a-1594-1833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/13/2021] [Indexed: 11/01/2022] Open
Abstract
Background and study aims Double-checking the findings of examinations is necessary for endoscopy quality control in gastric cancer screening; however, there have been no reports showing its effectiveness. We prospectively analyzed the effectiveness of a quality management system (QMS) in endoscopy for gastric cancer screening. Patients and methods QMS was defined as having images and reports checked by a second endoscopist on the same day and reporting inconsistencies to the examining endoscopist. Patients diagnosed with early gastric cancer (EGC) in the 2 years before and after the introduction of QMS were divided into two groups: the interval cancer group, which included those for whom cancer was detected within 1 year of the last endoscopy and the noninterval cancer group. Changes in detection rates were compared. Results Before the introduction of QMS, 11 interval EGC cases were diagnosed among 36,189 endoscopies, whereas after the introduction, 32 interval ECG cases were diagnosed among 38,290 endoscopies ( P = 0.004). Fifteen noninterval EGC cases were diagnosed before the introduction, while 12 noninterval EGC cases were diagnosed after the introduction; no significant difference was observed. Subanalyses by Helicobacter pylori (HP) infection status revealed no difference in the detection rate among HP-positive EGC patients, but the detection rates among HP-eradicated and HP-naïve EGC patients were improved ( P = 0.005 and P = 0.011). Logistic regression analysis showed that QMS was an independent predictor for detection of HP-negative interval EGC ( P = 0.017, OR = 4.4, 95 % CI: 2.0-9.7). Conclusions QMS improved the detection rate for HP-negative interval early gastric cancer. (UMIN000042991).
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Affiliation(s)
- Fumiaki Ishibashi
- Koganei Tsurukame Clinic, Endoscopy Center, Tokyo, Japan,Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan
| | | | | | - Ryu Tanaka
- Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan
| | - Kazuaki Sugihara
- Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan,Mirraza Shinjuku Tsurukame Clinic, Tokyo, Japan
| | - Satoshi Baba
- Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan,Yotsuya Medical Cube, Endoscopy Center, Tokyo, Japan
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Endoscopic characteristics in predicting prognosis of biopsy-diagnosed gastric low-grade intraepithelial neoplasia. Chin Med J (Engl) 2021; 135:26-35. [PMID: 34873080 PMCID: PMC8850827 DOI: 10.1097/cm9.0000000000001637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Endoscopic biopsy can underestimate gastric malignancies as low-grade intraepithelial neoplasia (LGIN). Definitively diagnosed LGIN would progress. This study aimed to evaluate predictive factors to identify malignancies misdiagnosed as LGIN by biopsy and LGIN at high risk of progression. METHODS The clinical records of patients diagnosed with gastric LGIN by endoscopic biopsy who underwent at least two endoscopies during the first year of follow-up between 2007 and 2017 were retrospectively collected. Three endoscopists reviewed photographs of the initial endoscopy, described lesion characteristics, and made endoscopic diagnoses. Logistic regression was used to analyze predictors to identify malignancies underestimated as LGIN. A receiver operating characteristic curve was used to evaluate the diagnostic accuracy of these predictors. Patient clinical outcomes of follow-up >1 year were collected. Kaplan-Meier estimates with log-rank tests and Cox proportional hazards regression were used to analyze predictors of progression. RESULTS Overall, 48 of 182 (26.4%) patients were proven to have malignancies. A single lesion, a large lesion size, and marked intestinal metaplasia (IM) were independent predictors of initially misdiagnosed malignancies. The area under the curve of these predictors was 0.871, with a sensitivity of 68.7% and specificity of 92.5%. Twelve of 98 patients (12.2%) progressed during the 33-month median follow-up period. A whitish appearance, irregular margins, marked IM, and histological diagnosis of LGIN more than twice within the first year were predictors for progression. CONCLUSIONS Lesions diagnosed as LGIN by biopsy with marked IM and other predictors above should be prudently treated for high potential to be malignancies or progress. Endoscopic follow-up with repeated biopsies within the first year is recommended.
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Gastric Cancers Missed at Upper Endoscopy in Central Norway 2007 to 2016-A Population-Based Study. Cancers (Basel) 2021; 13:cancers13225628. [PMID: 34830783 PMCID: PMC8616093 DOI: 10.3390/cancers13225628] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Stomach cancer may be missed during upper endoscopy. We have examined how often this occurs and identified factors associated with missed cancers. Among 730 patients with gastric cancer, 67 (9.2%) were missed during endoscopy 6 to 36 months prior to the cancer diagnosis. Missed cancers were more often located in the upper part of the stomach, of Lauren’s diffuse histologic type and more frequent in patients with previous Billroth II operation. The missed cancers were diagnosed at somewhat earlier stages than the non-missed cancers. In missed cancers, an ulceration was more often found in patients with shorter time interval between the first endoscopy and the endoscopy where the cancer was diagnosed. The factors associated with missed stomach cancers should be kept in mind by doctors performing endoscopies as this may lead to an earlier diagnosis of cancer. Abstract Background: The rates of missed gastric cancers (MGC) at upper endoscopy (UE) has been reported at 5–10% in Western countries. We aimed to calculate the rate of MGC and identify factors associated with MGC. Methods: Retrospective population-based cohort study including 730 patients diagnosed with gastric adenocarcinoma in Central Norway 2007–2016. MGCs were incident gastric adenocarcinomas diagnosed 6–36 months after a previous UE. Factors associated with MGC were examined. Definitely missed (UE 6–12 months prior) and potentially missed (UE 12–36 months prior) MGCs were compared. Results: Sixty-seven (9.2%) of 730 gastric cancers were MGC. MGC were associated with localization (p = 0.009) and more frequent in the corpus, Lauren’s histological type (p = 0.028) and diffuse type more prevalent, and previous Billroth 2-operation (14.9% vs. 4.7%, p = 0.001). MGCs were diagnosed at earlier stages (p = 0.037). An ulceration was more common in patients with definitely missed than potentially MGC (40.9% vs. 17.8%, p = 0.041). Conclusions: MGC accounted for 9.2% of gastric cancers in Central Norway. MGC were associated with localization in the corpus, Lauren´s diffuse type and previous Billroth-2-operation. Intensified follow-up and adequate biopsy sampling of patients with gastric ulcerations could reduce the rate of missed gastric cancers.
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Lim JH, Song JH, Chung SJ, Chung GE, Kim JS. Characteristics of interval gastric neoplasms detected within two years after negative screening endoscopy among Koreans. BMC Cancer 2021; 21:218. [PMID: 33653298 PMCID: PMC7923316 DOI: 10.1186/s12885-021-07929-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/17/2021] [Indexed: 01/10/2023] Open
Abstract
Background In Korea, where gastric cancer is highly prevalent, biennial endoscopy is recommended among individuals over 40. Even under regular screening, some are still diagnosed at advanced stages. We aimed to identify characteristics of interval gastric neoplasms (IGNs) with rapid progression. Results Newly-diagnosed gastric neoplasms detected in screening endoscopy between January 2004 and May 2016 were reviewed. Among them, those who had previous endoscopy within 2 years were enrolled. Endoscopic findings, family history of gastric cancer, smoking, and H. pylori status were analysed. Totally, 297 IGN cases were enrolled. Among them, 246 were endoscopically treatable IGN (ET-IGN) and 51 were endoscopically untreatable IGNs (EUT-IGN) by the expanded criteria for endoscopic submucosal dissection. Among EUT-IGNs, 78% were undifferentiated cancers (40/51) and 33% showed submucosal invasion (13/40). They were median 2.0 cm in size and more commonly located in the proximal stomach than ET-IGNs (70.6% vs. 41.9%, p < 0.001). EUT-IGN was independently related with age < 60 (OR, 2.09; 95%CI, 1.03–4.26, p = 0.042), H. pylori (OR, 2.81; 95%CI, 1.20–6.63, p = 0.018), and absent/mild gastric atrophy (OR, 2.67; 95%CI, 1.25–5.72, p = 0.011). Overall and disease-specific survival were not significantly different between the two groups, however EUT-IGN tended to have short disease-specific survival (overall survival, p = 0.143; disease-specific survival, p = 0.083). Conclusions Uniform screening endoscopy with two-year interval seems not enough for rapid-growing gastric neoplasms, such as undifferentiated cancers. They tended to develop in adults younger than 60 with H. pylori infection without severe gastric atrophy. More meticulous screening, especially for proximal lesions is warranted for adults younger than 60 with H. pylori infection before development of gastric atrophy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07929-y.
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Affiliation(s)
- Joo Hyun Lim
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 152, Teheran-ro, Gangnam-gu, Seoul, 06236, South Korea
| | - Ji Hyun Song
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 152, Teheran-ro, Gangnam-gu, Seoul, 06236, South Korea.
| | - Su Jin Chung
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 152, Teheran-ro, Gangnam-gu, Seoul, 06236, South Korea.
| | - Goh Eun Chung
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 152, Teheran-ro, Gangnam-gu, Seoul, 06236, South Korea
| | - Joo Sung Kim
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 152, Teheran-ro, Gangnam-gu, Seoul, 06236, South Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
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11
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Kim SJ, Choi CW. Common Locations of Gastric Cancer: Review of Research from the Endoscopic Submucosal Dissection Era. J Korean Med Sci 2019; 34:e231. [PMID: 31496141 PMCID: PMC6732260 DOI: 10.3346/jkms.2019.34.e231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/02/2019] [Indexed: 12/24/2022] Open
Abstract
Detection of early-stage gastric cancer improves the prognosis of patients. Endoscopic submucosal dissection (ESD) is a curative and stomach-preserving treatment for early gastric cancer (EGC) associated with a low risk of lymph node metastasis. However, several studies have reported missed diagnosis of gastric cancer. Therefore, endoscopists are required to learn accurate diagnostic skills to eliminate endoscopic blind spots. A systematic screening protocol to map the entire stomach without blind spots reduces the risk of missed lesions. Knowledge of the features of EGC or dysplasia is essential to identify suspicious lesion. Information of the common sites of occurrence of EGC can also enable a detailed endoscopic examination to improve detection rates. Previous reports investigating the location of gastric cancers resected by ESD or surgery showed that the antrum and lesser curvature of stomach were predominantly affected. Helicobacter pylori-induced atrophic changes advance from the antrum to the corpus along the lesser curvature, predominantly affecting these areas. Gastric cancers in the antrum and the lower corpus are also commonly missed during screening examination. Therefore, a careful examination of the lower third stomach is warranted to avoid missing synchronous and metachronous gastric lesions. Knowledge of the location of EGC enables accurate endoscopic examination and detection of EGC in early stage.
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Affiliation(s)
- Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
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Lee JY, Gong EJ, Chung EJ, Park HW, Bae SE, Kim EH, Kim J, Do YS, Kim TH, Chang HS, Song HJ, Choe J, Jung HY. The Characteristics and Prognosis of Diffuse-Type Early Gastric Cancer Diagnosed during Health Check-Ups. Gut Liver 2018; 11:807-812. [PMID: 28798286 PMCID: PMC5669596 DOI: 10.5009/gnl17033] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/09/2017] [Accepted: 03/12/2017] [Indexed: 12/17/2022] Open
Abstract
Background/Aims Because of the poor prognosis of diffuse-type gastric cancer, early detection is important. We investigated the clinical characteristics and prognosis of diffuse-type early gastric cancer (EGC) diagnosed in subjects during health check-ups. Methods Among 121,111 subjects who underwent gastroscopy during a routine health check-up, we identified 282 patients with 286 EGC lesions and reviewed their clinical and tumor-specific parameters. Results Patients with diffuse-type EGC were younger, and 48.1% of them were female. Serum anti-Helicobacter pylori IgG (Hp-IgG) was positive in 90.7% of diffuse-type EGC patients (vs 75.9% of intestinal-type EGC, p=0.002), and the proportion of diffuse-type EGC cases increased significantly with increasing Hp-IgG serum titers (p<0.001). Diffuse-type EGC had pale discolorations on the tumor surface (26.4% vs 4.0% in intestinal-type EGC, p<0.001) and were often located in the middle third of the stomach. Submucosal invasion or regional nodal metastasis was observed more commonly in patients with diffuse-type EGC. However, during the median follow-up period of 50 months, 5-year disease-free survival rates did not differ between the groups. Conclusions Diffuse-type EGC shows different clinical and endoscopic characteristics. Diffuse-type EGC is more closely associated with Hp-IgG seropositivity and a higher serum titer. Early detection results in excellent prognosis.
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Affiliation(s)
- Ji Young Lee
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jeong Gong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ju Chung
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Won Park
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suh Eun Bae
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Hee Kim
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaeil Kim
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon Suh Do
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hyup Kim
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Sook Chang
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewon Choe
- Health Screening and Promotion Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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13
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Iida T, Yamashita K, Ohwada S, Ohkubo Y, Hirano T, Miyake T, Onodera K, Kubo T, Yamano H, Nakase H. Natural history of gastric cancer from a retrospective review of endoscopic images of older patients with interval gastric cancer. Geriatr Gerontol Int 2018; 18:997-1002. [PMID: 29498489 DOI: 10.1111/ggi.13289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/04/2017] [Accepted: 01/24/2018] [Indexed: 11/30/2022]
Abstract
AIM Interval gastric cancers (IGC) are defined as those diagnosed after negative results of endoscopy carried out within the past 10 years. We aimed to investigate the characteristics of IGC and the natural history of gastric cancer (GC) from a retrospective view of endoscopic images of older patients with IGC. METHODS We retrospectively reviewed endoscopic images of 240 patients with GC who were aged >60 years. We compared past endoscopic images with newer ones, in which GC was diagnosed. IGC were classified into two categories: missed cancers and new cancers. RESULTS Of the 240 patients with GC, 32 had past endoscopic images that qualified for a precise review. A total of 14 cases involved new cancers, whereas 18 involved missed cancers. Most of the IGC were stage I for at least 2 years; however, a small subset was unresectable at >2 years after a negative endoscopy. Furthermore, the rate of endoscopic treatment was significantly higher for IGC compared with that for non-IGC. CONCLUSIONS In people aged >60 years, most IGC remain in an early stage for at least 2 years; however, at >2 years after a negative endoscopy, some are unresectable. These results suggest that most early-stage GC will not develop into advanced cancers within 2 years; thus, a 2-year interval might be within the permissible range for patients with negative endoscopy results for any lesions. Geriatr Gerontol Int 2018; 18: 997-1002.
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Affiliation(s)
- Tomoya Iida
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kentaro Yamashita
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sae Ohwada
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yosuke Ohkubo
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takehiro Hirano
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takakazu Miyake
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kei Onodera
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiyuki Kubo
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroo Yamano
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
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14
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Periodic Endoscopies Might Not Increase the Detection of Early Gastric Cancer in a Young Population. PLoS One 2016; 11:e0159759. [PMID: 27448311 PMCID: PMC4957784 DOI: 10.1371/journal.pone.0159759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 07/07/2016] [Indexed: 01/16/2023] Open
Abstract
Background Screening endoscopies in individuals 40 years or older in regions where gastric cancer is prevalent increase the diagnosis of gastric cancer at an early stage. However, the benefits of screening endoscopies in a young population (<40 years) have not been evaluated. Methods We reviewed data from patients less than 40 years old who underwent endoscopic submucosal dissection or surgery for initial-onset gastric cancer. We also administered a questionnaire to gather information concerning periodic endoscopic inspections and the period from the penultimate endoscopy to diagnosis. Results Of the 564 patients in this study, 101 (17.9%) patients underwent screening endoscopy within 24 months of their gastric cancer diagnosis. Lesion size was significantly smaller in the ≤24 months group than in the >24 month group (23.8 mm [standard deviation, 22.2 mm] vs. 30.5 mm [standard deviation, 23.1 mm], P = 0.008). However, the proportion of patients with early gastric cancer did not differ between the two groups (≤24 months vs. >24 months group; 67.6% vs. 65.7%, P = 0.712). On multivariable analysis, periodic endoscopies did not influence the early diagnosis of gastric cancer (with >24 months as the reference group: ≤24 months, odds ratio = 0.939, 95% confidence interval = 0.583–1.513). Conclusion Although periodic endoscopies aided in the detection of gastric cancer when lesions were smaller in size, they seemed not to increase the proportion of patients with early gastric cancer in young patients diagnosed with resectable gastric cancer.
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15
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Affiliation(s)
- Byung Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
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16
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Ji YB, Park CH, Kim H, Kim SH, Lee GM, Noh SK, Jeon TI, Son JH, Huh YM, Haam S, Oh SJ, Lee SK, Suh JS. Feasibility of terahertz reflectometry for discrimination of human early gastric cancers. BIOMEDICAL OPTICS EXPRESS 2015; 6:1398-406. [PMID: 25909023 PMCID: PMC4399678 DOI: 10.1364/boe.6.001398] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/04/2015] [Accepted: 03/16/2015] [Indexed: 05/13/2023]
Abstract
We have investigated the feasibility of THz time-domain reflectometry for the discrimination of human early gastric cancer (EGC) from the normal gastric region. Eight fresh EGC tissues, which were resected by endoscopic submucosal dissection, were studied. Of them, six lesions were well discriminated on THz images and the regions well correlated with tumor regions on pathologically mapped images. Four THz parameters could be suggested for quantitative discrimination of EGCs.
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Affiliation(s)
- Young Bin Ji
- Yonsei Institute of Convergence Technology, Yonsei University, Seoul 120-752,
South Korea
- These authors contributed equally to this work
| | - Chan Hyuk Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, 120-752,
South Korea
- These authors contributed equally to this work
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul 120-752,
South Korea
| | - Sang-Hoon Kim
- YUMC-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul 120-752,
South Korea
| | - Gyu Min Lee
- Graduate Program for Nanomedical Science, Yonsei University, Seoul 120-749,
South Korea
| | - Sam Kyu Noh
- Nano Materials Evaluation Center, Korea Research Institute of Standards and Science, Daejeon 305-340,
South Korea
| | - Tae-In Jeon
- Division of Electrical and Electronics Engineering, Korea Maritime University, Busan 606-791,
South Korea
| | - Joo-Hiuk Son
- Department of Physics, University of Seoul, Seoul 130-743,
South Korea
| | - Yong-Min Huh
- YUMC-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul 120-752,
South Korea
- Department of Radiology, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul 120-752,
South Korea
| | - Seungjoo Haam
- Yonsei Institute of Convergence Technology, Yonsei University, Seoul 120-752,
South Korea
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul 120-749,
South Korea
| | - Seung Jae Oh
- YUMC-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul 120-752,
South Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, 120-752,
South Korea
| | - Jin-Suck Suh
- YUMC-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul 120-752,
South Korea
- Department of Radiology, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul 120-752,
South Korea
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