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The impact of pre-resection endoscopic examination time on the rate of synchronous gastric neoplasms missed during endoscopic treatment

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Abstract

Background and study aims

Synchronous multiple gastric cancers have been reported in up to 14% of patients, but few efforts have been made to optimize techniques for detection of multiple neoplasms. We sought to evaluate whether the length of endoscopic examination before endoscopic resection affected the detection rates of synchronous gastric neoplasms.

Patients and methods

Among patients referred for endoscopic treatment of gastric neoplasms (n = 1,017), we enrolled those in whom at least one other synchronous neoplasm was found during pre-resection endoscopy or during the 1-year follow-up examination. Pre-resection endoscopic examination time was compared between those in whom multiple neoplasms were completely diagnosed before resection (complete examination group) and those in whom multiple neoplasms were not fully diagnosed prior to resection but were found during follow-up evaluation (incomplete examination group).

Results

Eighty-three patients were included in the study. We found no significant difference in any of the multiplicity, location, gross appearance, size, or resection type of primary lesion between the complete (n  =  46) and incomplete examination (n  = 37) groups. The complete examination group had a significantly longer examination time compared to the incomplete examination group (6.5 ± 2.4 min vs. 3.8 ± 1.8 min, respectively; P < 0.001). The synchronous lesions most commonly presented as the flat type (42/94 lesions, 45%) and were smaller than the primary lesions (10.0 ± 7.4 mm vs. 14.3 ± 9.1 mm, respectively; P = 0.002).

Conclusions

Endoscopists should consider the possibility of synchronous gastric neoplasms and examine the whole stomach, thus allowing adequate time to reduce the risk of missed lesions.

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References

  1. Soetikno R, Kaltenbach T, Yeh R, Gotoda T (2005) Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 23:4490–4498

    Article  PubMed  Google Scholar 

  2. Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Ohnita K, Mizuta Y, Shiozawa J, Kohno S (2009) Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 58:331–336

    Article  CAS  PubMed  Google Scholar 

  3. Goto O, Fujishiro M, Kodashima S, Ono S, Omata M (2009) Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 41:118–122

    Article  CAS  PubMed  Google Scholar 

  4. Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235

    Article  PubMed  Google Scholar 

  5. Yalamarthi S, Witherspoon P, McCole D, Auld CD (2004) Missed diagnoses in patients with upper gastrointestinal cancers. Endoscopy 36:874–879

    Article  CAS  PubMed  Google Scholar 

  6. Amin A, Gilmour H, Graham L, Paterson-Brown S, Terrace J, Crofts TJ (2002) Gastric adenocarcinoma missed at endoscopy. J R Coll Surg Edinb 47:681–684

    CAS  PubMed  Google Scholar 

  7. Correa P, Haenszel W, Cuello C, Tannenbaum S, Archer M (1975) A model for gastric cancer epidemiology. Lancet 2:58–60

    Article  CAS  PubMed  Google Scholar 

  8. Kang GH, Kim CJ, Kim WH, Kang YK, Kim HO, Kim YI (1997) Genetic evidence for the multicentric origin of synchronous multiple gastric carcinoma. Lab Invest 76:407–417

    CAS  PubMed  Google Scholar 

  9. Moertel CG, Bargen JA, Soule EH (1957) Multiple gastric cancers; review of the literature and study of 42 cases. Gastroenterology 32:1095–1103

    CAS  PubMed  Google Scholar 

  10. Everett SM, Axon AT (1997) Early gastric cancer in Europe. Gut 41:142–150

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Nasu J, Doi T, Endo H, Nishina T, Hirasaki S, Hyodo I (2005) Characteristics of metachronous multiple early gastric cancers after endoscopic mucosal resection. Endoscopy 37:990–993

    Article  CAS  PubMed  Google Scholar 

  12. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL (2006) Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 355:2533–2541

    Article  CAS  PubMed  Google Scholar 

  13. Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, Lieb JG 2nd, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Wani S, Weinberg DS (2015) Quality indicators for colonoscopy. Gastrointest Endosc 81:31–53

    Article  PubMed  Google Scholar 

  14. Teh JL, Tan JR, Lau LJ, Saxena N, Salim A, Tay A, Shabbir A, Chung S, Hartman M, So JB (2015) Longer examination time improves detection of gastric cancer during diagnostic upper gastrointestinal endoscopy. Clin Gastroenterol Hepatol 13(480–487):e482

    Google Scholar 

  15. Gupta N, Gaddam S, Wani SB, Bansal A, Rastogi A, Sharma P (2012) Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointest Endosc 76:531–538

    Article  PubMed  Google Scholar 

  16. Bisschops R, Areia M, Coron E, Dobru D, Kaskas B, Kuvaev R, Pech O, Ragunath K, Weusten B, Familiari P, Domagk D, Valori R, Kaminski MF, Spada C, Bretthauer M, Bennett C, Senore C, Dinis-Ribeiro M, Rutter MD (2016) Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 48:843–864

    Article  PubMed  Google Scholar 

  17. Yoo JH, Shin SJ, Lee KM, Choi JM, Wi JO, Kim DH, Lim SG, Hwang JC, Cheong JY, Yoo BM, Lee KJ, Kim JH, Cho SW (2013) How can we predict the presence of missed synchronous lesions after endoscopic submucosal dissection for early gastric cancers or gastric adenomas? J Clin Gastroenterol 47:e17–e22

    Article  PubMed  Google Scholar 

  18. Kimura K, Takemoto T (1969) An Endoscopic Recognition of the Atrophic Border and its Significance in Chronic Gastritis. Endoscopy 1:87–97

    Article  Google Scholar 

  19. Sanchez W, Harewood GC, Petersen BT (2004) Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy. Am J Gastroenterol 99:1941–1945

    Article  PubMed  Google Scholar 

  20. Fatima H, Rex DK, Rothstein R, Rahmani E, Nehme O, Dewitt J, Helper D, Toor A, Bensen S (2008) Cecal insertion and withdrawal times with wide-angle versus standard colonoscopes: a randomized controlled trial. Clin Gastroenterol Hepatol 6:109–114

    Article  PubMed  Google Scholar 

  21. Simmons DT, Harewood GC, Baron TH, Petersen BT, Wang KK, Boyd-Enders F, Ott BJ (2006) Impact of endoscopist withdrawal speed on polyp yield: implications for optimal colonoscopy withdrawal time. Aliment Pharmacol Ther 24:965–971

    Article  CAS  PubMed  Google Scholar 

  22. Sasako M, Inoue M, Lin JT, Khor C, Yang HK, Ohtsu A (2010) Gastric Cancer Working Group report. Jpn J Clin Oncol 40(Suppl 1):i28–i37

    Article  PubMed  Google Scholar 

  23. Yao K (2013) The endoscopic diagnosis of early gastric cancer. Ann Gastroenterol 26:11–22

  24. Eckardt VF, Giessler W, Kanzler G, Remmele W, Bernhard G (1990) Clinical and morphological characteristics of early gastric cancer. A case-control study. Gastroenterology 98:708–714

    Article  CAS  PubMed  Google Scholar 

  25. Marrano D, Viti G, Grigioni W, Marra A (1987) Synchronous and metachronous cancer of the stomach. Eur J Surg Oncol 13:493–498

    CAS  PubMed  Google Scholar 

  26. Jang MY, Cho JW, Oh WG, Ko SJ, Han SH, Baek HK, Lee YJ, Kim JW, Jung GM, Cho YK (2013) Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection. Korean J Intern Med 28:687–693

    Article  PubMed  PubMed Central  Google Scholar 

  27. Heresbach D, Barrioz T, Lapalus MG, Coumaros D, Bauret P, Potier P, Sautereau D, Boustiere C, Grimaud JC, Barthelemy C, See J, Serraj I, D’Halluin PN, Branger B, Ponchon T (2008) Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 40:284–290

    Article  CAS  PubMed  Google Scholar 

  28. Han JS, Jang JS, Ryu HC, Kim MC, Kim KH, Kim DK (2015) Risk factors associated with multiple and missed gastric neoplastic lesions after endoscopic resection: prospective study at a single institution in south Korea. Hepatogastroenterology 62:512–517

    PubMed  Google Scholar 

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Acknowledgements

This research was supported by the National Research Foundation of Korea grant funded by the Ministry of Science, ICT & Future Planning (NRF-2016R1C1B2015185 and NRF-2013R1A1A2007985) and by the program of Global Research and Development Center through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (NRF-2011-0031644).

Author contributions

HHL and JMP designed and initiated the study, acquired the data, analyzed the results of the statistical analyses, and wrote the paper. SBY, CHL, JSK, YKC, BIL, YSC, and MGC acquired the data, analyzed the data and revised the paper.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea

    Han Hee Lee, Jae Myung Park, Chul-Hyun Lim, Jin Su Kim, Yu Kyung Cho & Myung-Gyu Choi

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  1. Han Hee Lee
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  2. Jae Myung Park
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Correspondence to Jae Myung Park.

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Disclosures

All authors, Han Hee Lee, Jae Myung Park, Chul-Hyun Lim, Jin Su Kim, Yu Kyung Cho, and Myung-Gyu Choi have no conflict of interest or any potential benefit in any form of a commercial party related directly or indirectly to the subject of the manuscript.

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Lee, H.H., Park, J.M., Lim, CH. et al. The impact of pre-resection endoscopic examination time on the rate of synchronous gastric neoplasms missed during endoscopic treatment. Surg Endosc 31, 3952–3960 (2017). https://doi.org/10.1007/s00464-017-5428-x

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  • DOI: https://doi.org/10.1007/s00464-017-5428-x

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