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Background and Aims
As endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) preserves the entire stomach, missed gastric cancers (MGCs) are often found in the remaining gastric mucosa. However, the endoscopic causes of MGCs remains unclear. Therefore, we aimed to elucidate the endoscopic causes and characteristics of MGCs after ESD.
From January 2009 to December 2018, all patients with ESD for initially detected EGC were enrolled. According to a review of esophagogastroduodenoscopy (EGD) images before ESD, we identified the endoscopic causes (perceptual, exposure, sampling errors, and inadequate preparation) and characteristics of MGC in each endoscopic cause.
In total, 2208 patients who underwent ESD for initial EGC were analyzed. Of these, 82 (3.7%) patients had 100 MGCs. The breakdown of the endoscopic causes of MGCs was as follows: 69 (69%) perceptual errors, 23 (23%) exposure errors, 7 (7%) sampling errors, and 1 (1%) inadequate preparation. Logistic regression analysis showed that the risk factors for perceptual error were male sex (Odds ratio [OR], 2.45; 95% Confidence interval [CI], 1.16-5.18), isochromatic coloration (OR, 3.17; 95% CI, 1.47–6.84), greater curvature (OR, 2.31; 95% CI, 1.121–4.40), and lesion size ≤12 mm (OR, 1.74; 95% CI, 1.07–2.84). The sites of exposure errors were around incisura angularis, 11 (48%); posterior wall of the gastric body, 6 (26%); and antrum, 5 (21%).
We identified MGCs in four categories and clarified their characteristics. Quality improvements in EGD observation, with attention to the risks of perceptual and site of exposure errors, can potentially prevent missing EGCs.
Abbreviations and Acronyms:CI (confidence interval), EGC (early gastric cancer), EGD (esophagogastroduodenoscopy), ESD (endoscopic submucosal dissection), H. Pylori (Helicobacter pylori), IQR (medians and interquartile range), MGC (missed gastric cancer), OR (odds ratio)
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Accepted: February 20, 2023
Received in revised form: February 10, 2023
Received: November 3, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 by the American Society for Gastrointestinal Endoscopy