A 13-year Study of Missed Gastric Adenoma After Screening Esophagogastroduodenoscopy

Aims “Missed” gastric adenomas are still unknown. This study aimed to investigate missed gastric adenoma in screening EGD.

Methods This was a retrospective review of 93,676 patients between 2007 and 2019 who underwent screening EGD by endoscopists at the Health Promotion Center. Missed gastric adenoma was defined as a “no adenoma” result by EGD within 3 years before the diagnosis on screening EGD. Data on age, gender, endoscopist experience, procedure time, and pathological features of the gastric adenoma.

Results Of the 93,676 EGDs performed, 295 gastric adenomas were identified, including 95 (0.1%) missed adenomas and 200 (0.2%) newly detected adenomas. In univariate analysis, male, endoscopist experience, procedure time, and presence of gastric intestinal metaplasia (pathologically proven) was associated with missed adenomas. Multivariate analysis showed the gastric intestinal metaplasia (odds ratio [OR]: 2.736, 95% confidence interval [CI]: 1.320-5.667, P=0.007) and shorter procedure time of the index screening EGD (B: -0.011, OR: 0.990, 95% CI: 0.986-0.993, P<0.001) were independent predictors of missed gastric adenomas. The optimal cutoff for the procedure time for detecting gastric adenomas was 3 minutes and 32 seconds (area under curve, 0.738; 95% CI: 0.677-0.799, P<0.001).

Conclusions Gastric intestinal metaplasia in screening EGD is a signal of missed gastric adenoma. EGD should also be performed for more than 3 minutes and 32 seconds to ensure detection of gastric adenoma. Therefore, procedure time and careful inspection of gastric mucosa with gastric intestinal metaplasia are quality indicator of screening EGD in detection of gastric adenoma.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025