Skip to main content

Endoscopic Quality Indicators for Esophagogastroduodenoscopy in Gastric Cancer Screening



Quality indicators of screening esophagogastroduodenoscopy are essential to improve the detection rate of gastric cancer. However, a reliable, practical indicator of the performance of endoscopists in screening esophagogastroduodenoscopy has not yet been identified.


We aimed to identify quality indicators of esophagogastroduodenoscopy for the detection of early gastric neoplasms, including gastric dysplasia and early gastric cancer, focusing on the endoscopic findings.


The records of 54,889 individuals who underwent esophagogastroduodenoscopy for gastric cancer screening at the Yonsei University Severance Hospital Health Promotion Center, Seoul, Korea, between February 2006 and July 2013 were analyzed. The detection rates for various gastric lesions including early gastric neoplasms were analyzed for each endoscopist.


Gastric dysplasia, early gastric cancer, and advanced gastric cancer were detected in 97 (0.18 %), 54 (0.10 %), and 21 (0.04 %) of 54,889 individuals, respectively. Multivariate analysis showed that the detection rates of gastric subepithelial lesions and gastric diverticuli were independent factors associated with the detection rate of early gastric neoplasms (regression coefficients of 0.096 and 0.532, respectively). A quality score formula was deduced using these regression coefficients to predict the ability of an endoscopist to detect early gastric neoplasms. A trend test confirmed that the group of endoscopists with a higher quality score showed a significantly higher rate of early gastric neoplasm detection (P < 0.001).


The detection rates of gastric subepithelial lesions and gastric diverticuli are well correlated with that of early gastric neoplasms. In addition, the proposed quality scoring system could be a good quality indicator for the detection of early gastric neoplasms.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Correa P. A human model of gastric carcinogenesis. Cancer Res. 1988;48:3554–3560.

    CAS  PubMed  Google Scholar 

  2. Vieth M, Stolte M. Elevated risk for gastric adenocarcinoma can be predicted from histomorphology. World J Gastroenterol. 2006;12:6109–6114.

    PubMed Central  PubMed  Google Scholar 

  3. Adamu MA, Weck MN, Gao L, et al. Incidence of chronic atrophic gastritis: systematic review and meta-analysis of follow-up studies. Eur J Epidemiol. 2010;25:439–448.

    PubMed  Article  Google Scholar 

  4. Ohata H, Kitauchi S, Yoshimura N, et al. Progression of chronic atrophic gastritis associated with Helicobacter pylori infection increases risk of gastric cancer. Int J Cancer. 2004;109:138–143.

    CAS  PubMed  Article  Google Scholar 

  5. Miki K. Gastric cancer screening by combined assay for serum anti-Helicobacter pylori IgG antibody and serum pepsinogen levels—“ABC method”. Proc Jpn Acad Ser B Phys Biol Sci. 2011;87:405–414.

    PubMed Central  PubMed  Article  Google Scholar 

  6. Vradelis S, Maynard N, Warren BF, et al. Quality control in upper gastrointestinal endoscopy: detection rates of gastric cancer in Oxford 2005–2008. Postgrad Med J. 2011;87:335–339.

    CAS  PubMed  Article  Google Scholar 

  7. Suh M, Choi KS, Lee YY, et al. Trends in cancer screening rates among Korean men and women: results from the Korean National Cancer Screening Survey, 2004–2012. Cancer Res Treat. 2013;45:86–94.

    PubMed Central  PubMed  Article  Google Scholar 

  8. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    PubMed  Article  Google Scholar 

  9. Lee HJ, Yang HK, Ahn YO. Gastric cancer in Korea. Gastric Cancer. 2002;5:177–182.

    PubMed  Article  Google Scholar 

  10. Inoue M, Tsugane S. Epidemiology of gastric cancer in Japan. Postgrad Med J. 2005;81:419–424.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  11. Isobe Y, Nashimoto A, Akazawa K, et al. Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry. Gastric Cancer. 2011;14:301–316.

  12. Axon A. Symptoms and diagnosis of gastric cancer at early curable stage. Best Pract Res Clin Gastroenterol. 2006;20:697–708.

    PubMed  Article  Google Scholar 

  13. Nam SY, Choi IJ, Park KW, et al. Effect of repeated endoscopic screening on the incidence and treatment of gastric cancer in health screenees. Eur J Gastroenterol Hepatol. 2009;21:855–860.

    PubMed  Article  Google Scholar 

  14. Chung SJ, Park MJ, Kang SJ, et al. Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea. Int J Cancer. 2012;131:2376–2384.

    CAS  PubMed  Article  Google Scholar 

  15. Cohen J, Safdi MA, Deal SE, et al. Quality indicators for esophagogastroduodenoscopy. Am J Gastroenterol. 2006;101:886–891.

    PubMed  Article  Google Scholar 

  16. Faigel DO, Pike IM, Baron TH, et al. Quality indicators for gastrointestinal endoscopic procedures: an introduction. Am J Gastroenterol. 2006;101:866–872.

    PubMed  Article  Google Scholar 

  17. Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–255.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  18. Iwakiri K, Hayashi Y, Sakamoto C. The diversity of gastric carcinoma. Berlin: Springer; 2005:185–202.

    Book  Google Scholar 

  19. Moons KG, Harrell FE, Steyerberg EW. Should scoring rules be based on odds ratios or regression coefficients? J Clin Epidemiol. 2002;55:1054–1055.

    PubMed  Article  Google Scholar 

  20. Lochhead P, El-Omar EM. Gastric cancer. Br Med Bull. 2008;85:87–100.

    PubMed  Article  Google Scholar 

  21. Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–1803.

    CAS  PubMed  Article  Google Scholar 

  22. Barclay RL, Vicari JJ, Doughty AS, et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–2541.

    CAS  PubMed  Article  Google Scholar 

  23. Lieberman D, Nadel M, Smith RA, et al. Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. Gastrointest Endosc. 2007;65:757–766.

    PubMed  Article  Google Scholar 

  24. Nishida T, Kawai N, Yamaguchi S, et al. Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc. 2013;25:479–489.

  25. Rashid F, Aber A, Iftikhar SY. A review on gastric diverticulum. World J Emerg Surg. 2012;7:1.

    PubMed Central  PubMed  Article  Google Scholar 

  26. The Korean Society of Gastrointestinal Endoscopy. Atlas of gastrointestinal endoscopy, 1st ed. London: Medbook Co., Ltd.; 2011.

  27. Oviedo J, Swan N, Farraye FA. Gastric xanthomas. Am J Gastroenterol. 2001;96:3216–3218.

    CAS  PubMed  Article  Google Scholar 

  28. Leung WK, Wu M, Kakugawa Y, et al. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol.. 2008;9:279–287.

    PubMed  Article  Google Scholar 

  29. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–362.

    PubMed Central  PubMed  Google Scholar 

  30. Dhobi MA, Wani KA, Parray FQ, et al. Gastric cancer in young patients. Int J Surg Oncol.. 2013;2013:981654.

    PubMed Central  PubMed  Google Scholar 

  31. Rugge M, Correa P, Di Mario F, et al. OLGA staging for gastritis: a tutorial. Dig Liver Dis.. 2008;40:650–658.

    CAS  PubMed  Article  Google Scholar 

  32. Capelle LG, de Vries AC, Haringsma J, et al. The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis. Gastrointest Endosc. 2010;71:1150–1158.

    PubMed  Article  Google Scholar 

  33. Satoh K, Kimura K, Taniguchi Y, et al. Distribution of inflammation and atrophy in the stomach of Helicobacter pylori-positive and -negative patients with chronic gastritis. Am J Gastroenterol. 1996;91:963–969.

    CAS  PubMed  Google Scholar 

  34. Ito S, Azuma T, Murakita H, et al. Profile of Helicobacter pylori cytotoxin derived from two areas of Japan with different prevalence of atrophic gastritis. Gut. 1996;39:800–806.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  35. Liu Y, Uemura N, Xiao S, et al. Agreement between endoscopic and histological gastric atrophy scores. J Gastroenterol. 2005;40:123–127.

    PubMed  Article  Google Scholar 

  36. Nagata N, Shimbo T, Akiyama J, et al. Predictability of gastric intestinal metaplasia by mottled patchy erythema seen on endoscopy. Gastroenterol Res.. 2011;4:203–209.

    Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Yong Chan Lee.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Park, C.H., Kim, B., Chung, H. et al. Endoscopic Quality Indicators for Esophagogastroduodenoscopy in Gastric Cancer Screening. Dig Dis Sci 60, 38–46 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Quality indicator
  • Endoscopist
  • Gastric neoplasm
  • Detection