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The optimal endoscopic
screening interval for detecting
early gastric neoplasms
CH Park, EH Kim, HS Chung, H Lee, JC Park, SK Shin, YC Lee,
JY An, HI Kim, JH Cheong, WJ Hyung, SH Noh, CB Kim, SK Lee
GASTROINTESTINAL ENDOSCOPY 2014;80:253-9.
F1 손주웅
Introduction

Gastric cancer
• the major causes of cancer-related death worldwide
• almost 990,000 cases are detected annually
• The prognosis depends on the tumor stage

The National Cancer Screening Program in Korea
• biennial gastric cancer screening for adults aged 40
years and older

United Kingdom–based study
• Annual endoscopic surveillance in patients with
•
atrophic gastritis or intestinal metaplasia
detect most new tumors sufficiently early to allow a
major improvement in survival
Introduction

Many reports suggested that 2 to 3 years is an
optimal screening interval
• included a relatively small number of patients with gastric
cancer
• no patients with gastric adenoma

The optimal interval between endoscopic
examinations for detecting early gastric
neoplasms, including gastric adenomas, has not
previously been studied.
Introduction

It is important to include adenoma in these
studies for several reasons
• almost all adenomas that were resected by endoscopic
•

submucosal dissection (ESD) were diagnosed by
endoscopic screening.
endoscopic screening aims both to reduce gastric cancerrelated mortality and to detect gastric neoplasms that can
be treated in a way that better preserves organs, compared
with surgery.
This study aimed
• to evaluate the optimal interval between endoscopic
examinations for the early diagnosis of both gastric cancers
and adenomas.
METHODS

Patients
• diagnosed with gastric neoplasms including gastric
•
adenoma and gastric cancer in Severance Hospital,
between January 2008 and August 2013.
a questionnaire survey by interview at outpatient
clinics or by a telephone poll.
METHODS
METHODS

Treatment method
• EGCs that appeared to meet the indication for ESD were treated
with ESD
• differentiated intramucosal adenocarcinoma <3 cm in diameter
•
•
•
without lymphovascular invasion, irrespective of ulcer findings
differentiated intramucosal adenocarcinoma without
lymphovascular invasion and negative for ulceration, irrespective of
tumor size
undifferentiated intramucosal cancer <2 cm without
lymphovascular invasion and ulcer findings
differentiated adenocarcinomas <3 cm with minimal submucosal
invasion (<500 ㎛) and without lymphovascular invasion
• Patients who were diagnosed with adenoma underwent ESD.
METHODS

Gross and histopathologic evaluation
• Tumor location
• endoscopically evaluated
• classified by the Japanese Gastric Cancer Association
Classification criteria
• Tumor size, invasion depth, the presence of an ulcer,
lymphatic and vascular involvement, and lymph node
metastasis
• histopathologically assessed
• Pathologic stages
• the 7th edition of the American Joint Committee on
Cancer/ Union Internationale Contre le Cancer tumornode-metastasis staging system
RESULTS

Clinicopathologic characteristics
66%
50.7%
31.1%
RESULTS

Optimal interval between endoscopic
examinations
RESULTS

Effect of endoscopy screening interval on
possibility of ESD and lesion stage
Conclusion


Annual endoscopy cannot facilitate the detection
of endoscopically treatable gastric neoplasms
compared with biennial or triennial endoscopy.
This study recommend biennial endoscopic
screening for gastric neoplasms
• increase the proportion of lesions discovered while
•
they are still endoscopically treatable
to reduce the number of lesions that progress to
advanced gastric cancer.