FACTORS INFLUENCING THE MISSED DIAGNOSIS OF EARLY GASTRIC CANCER OR HIGH-GRADE DYSPLASIA

Aims:

Endoscopy plays very important role in the diagnosis of gastric cancer. Unfortunately, early gastric cancer and HGD are often associated with subtle mucosal changes and can be easily overlooked. The aim of the current study was to determine the procedure and physician-related factors that influence the missed diagnosis of early gastric cancer or HGD.

Methods:

Data from 13 patients with early gastric cancer or HGD diagnosed within 6 months from previous “negative” endoscopy were retrospectively analyzed. Procedure-related factor such as: duration of the examination, number of endo-photos taken, stomach preparation (antifoaming agents before procedure), use of chromoendoscopy and type of endoscope (HD vs. not HD), as well as physician-related factors – experience (more or less than 10 years) and special training in early cancer detection have been obtained.

Results:

Totaly 19 cases of early cancer or HGD in 13 patients have been diagnosed during second look (“positive”) endoscopy. Average tumor size was 13,3 ± 1.4 mm. All tumors were type II according to Paris classification and more then half of them localized in the stomach body.

“Negative” endoscopy was shorter than “positive” (5.5 ± 0.4 vs. 8.5 ± 0.6 min, p = 0.000258), with less number of endo-photos taken (8 ± 2 vs. 16 ± 2, p = 0.00019). Stomach preparation, as well as chromoendoscopy, were less common in “negative” group (p = 0.015 and p = 0.00002, respectively). There was no difference in endoscope type between the two groups.

Doctors with special training on early cancer detection more often performed “positive” than “negative” endoscopy (p = 0.047), but doctor's experience did not differ significantly in the two groups.

Conclusions:

Longer examination with chromoendoscopy and multiple endo-photos in conjunction with preprocedural stomach preparation performed by the trained doctor can improve early cancer and HGD detection rate.