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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
F1 손주웅
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
Many reports suggested that 2 to 3 years is an
optimal screening interval
• included a relatively small number of patients with gastric
• no patients with gastric adenoma
The optimal interval between endoscopic
examinations for detecting early gastric
neoplasms, including gastric adenomas, has not
previously been studied.
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.
• 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.
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.
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
• histopathologically assessed
• Pathologic stages
• the 7th edition of the American Joint Committee on
Cancer/ Union Internationale Contre le Cancer tumornode-metastasis staging system
Clinicopathologic characteristics
Optimal interval between endoscopic
Effect of endoscopy screening interval on
possibility of ESD and lesion stage
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.