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ABSTRACT
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.
Methods
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.
Results
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%).
Conclusions
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.
Key words
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)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
February 20,
2023
Received in revised form:
February 10,
2023
Received:
November 3,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
