Interval Advanced Gastric Cancer After Negative Endoscopy

Risk factors of missed early gastric cancer in endoscopic resected population: a retrospective, case-control study

BACKGROUND

Missed early gastric cancer (MEGC) is prevalent during esophagogastroduodenoscopy (EGD), which is the first-line recommended strategy for detecting early gastric cancer (EGC). Hence, we explored the risk factors for MEGC and different types of MEGC, based on the endoscopic resected population.

METHODS

This retrospective, case-control study was conducted at Nanjing Drum Tower Hospital (NJDTH). We included patients who were diagnosed with EGC during screening EGD, underwent endoscopic resection, and were confirmed by postoperative pathology at the NJDTH from January 2014 to December 2021, and classified them into different types according to the different root causes of misses. Univariable, multivariable, subgroup and propensity score analyses were used to explore the risk factors for MEGC and different types of MEGC.

RESULTS

A total of 447 patients, comprising 345 with initially detected early gastric cancer (IDEGC) and 102 with MEGC, were included in this study. Larger size (≥ 1 cm) (OR 0.45, 95% CI 0.27-0.74, P = 0.002) and invasion depth of submucosa (OR 0.26, 95% CI 0.10-0.69, P = 0.007) were negatively associated with MEGC. Use of sedation (OR 0.32, 95% CI 0.20-0.52, P < 0.001) and longer observation time (OR 0.60, 95% CI 0.37-0.96, P = 0.034) exhibited protective effect on MEGC.

CONCLUSIONS

Smaller and more superficial EGC lesions are more susceptible to misdiagnosis. The use of sedation and prolonged observation time during EGD could help reduce the occurrence of MEGC.

Progress in research of tumor biomarkers and molecular imaging probes for gastric cancer

Gastric cancer is a malignant tumor still associated with high morbidity and mortality worldwide. Its onset is relatively insidious, and when detected, it is already at an advanced stage, lacks effective individualized treatments, and has a poor prognosis. If gastric cancer can be diagnosed at an early stage, the survival rate of patients can be greatly improved. However, traditional imaging modalities lack specificity and sensitivity. In recent years, molecular imaging technology is booming, which can non-invasively and dynamically monitor gastric cancer at the cellular and molecular levels, and provide more reference information for clinical selection of treatment options and assessment of efficacy and prognosis. This article reviews the biomarkers of gastric cancer and molecular probes in various imaging modalities.

Esophagogastroduodenoscopy Outcomes Variated by the Time of the Day: A Single-Center Experience

(1) Background: To assess whether the start time influences the outcomes of esophagogastroduodenoscopy (EGD). (2) Methods: We retrospectively analyzed the clinical data of patients who underwent EGD between January 2021 and December 2021 in our endoscopy center. The EGD were divided into three shifts, according to the start time. The lesion detection rate (LDR) and endoscopy biopsy rate (EBR) were used to evaluate the quality of the EGD. (3) Results: A total of 14,597 procedures were included in this study. The LDR of shift 2 was significantly lower than that of shift 1 (62.4% vs. 58.5%; p < 0.001). The EBR of shift 1 (37.4% vs. 31.5%; p < 0.001) and shift 3 (35.5% vs. 31.5%; p = 0.024) were significantly higher than that of shift 2; the EBR in shift 1 did not differ significantly from shift 3 (p = 0.280). The multivariable analysis for the EGD performed before 14:00 demonstrated a graded decrease in the LDR and EBR after adjusting the confounders (p < 0.001). (4) Conclusion: In a continuous working period, the lesion detection and biopsy submission of EGD are superior to those in the first three hours compared to the last three hours; the LDR and EBR decreased as the day progressed, probably due to the endoscopists' fatigue.