Effectiveness of systematic alphanumeric coded endoscopy for diagnosis of gastric intraepithelial neoplasia in a low socioeconomic population

Abstract

Background and study aims: In the Western world, gastric cancer (GC) usually presents at an advanced stage, carrying a high mortality rate. Studies have reported that 14 % to 26 % of GCs are missed at endoscopy up to 3 years before diagnosis. Systematic Alphanumeric Coded Endoscopy (SACE) has been proposed to improve quality of esophagogastroduodenoscopy (EGD) by facilitating a complete examination of the upper gastrointestinal tract. This prospective cross-sectional study was designed to determine the frequency of gastric intraepithelial neoplasia (GIN) by using the SACE approach in cohort of patients from low socioeconomic level. It also used non-targeted biopsies to evaluate the frequency of premalignant conditions. Patients and methods: A total of 601 consecutive asymptomatic or dyspeptic patients were enrolled between January 2013 and November 2014 at the Huacho regional hospital in Peru. The SACE method proposed by Emura et al, which divides the stomach into 5 regions and 21 areas, was routinely used for diagnosis. Biopsy samples were obtained from any endoscopically detected focal lesion. To evaluate gastric premalignant conditions, 4 non-targeted biopsies were taken. Results: A total of 573 patients were analyzed. The mean age was 57 years, and the female:male ratio was 1.9 : 1. In all cases, complete photo-documentation of the 21 gastric areas was achieved. The overall rate of detection of GIN was 2.8 %. Low-grade displasia, high-grade dysplasia, and adenocarcinoma were found in 13 (2.3 %), 2 (0.3 %), and 1 (0.2 %) of the patients, respectively. The prevalence of at least 1 premalignant condition was 31 %, and helicobacter pylori infection was found in 57 % of patients. Conclusions: Using the SACE approach and with proper training, we have reported herein a high frequency of GIN in patients from a low socioeconomic status. Gastric cancer detection can be improved in a Western endoscopy setting when SACE, as a screening method, is performed by a trained endoscopist.

Principles and practice to facilitate complete photodocumentation of the upper gastrointestinal tract: World Endoscopy Organization position statement

“…This WEO position statement constitutes a guide for complete photodocumentation of the upper GI mucosal lining, fulfilling the high‐quality recommendations set by major endoscopy organizations regarding complete mucosal observation and appropriate documentation . This examination, also known as systematic alphanumeric coded endoscopy (SACE), facilitates complete examination by photodocumenting 28 unique areas, from the hypopharynx to the second portion of the duodenum . To achieve completeness, areas to be registered are numbered from 1 to 28 providing examiners the sequence of the procedure (Video S1).…”

“…In our opinion, beyond the scope of risk‐based cancer screening, this approach may be applied as a guide for completeness in all patients. Complete photodocumentation has been applied in Colombia since 2006 and, thereafter, in other Latin American countries with a high incidence of gastric cancer resulting in higher cancer detection rates . Although randomized trials are needed to prove its effectiveness, at present, it provides a better definition of a complete procedure and should be ideally considered a quality improvement compared to previous non‐standardized procedures.…”

“…These landmarks include the epithelial transition zone at the greater curvature of the lower third; the gastric spur, an external compression at the posterior wall of the middle third; the fornix, the pocket‐like upper part of the upper body; and the cardia, the opening forming the junction in retroflex view between the esophagus and the stomach . Identification of these landmarks along with the anterior and posterior walls, the lesser and greater curvatures, and the stomach sections, constitute the rationale to luminally divide the stomach into five large regions: the pyloric channel and the antrum; the lower, middle and upper thirds; and the lesser curvature, which in total comprise 21 different areas (Table ).…”

“…In this regard, the European Society of Gastrointestinal Endoscopy (ESGE) has stated that photodocumentation of all anatomical landmarks during upper GI endoscopy can be considered an indicator of a complete examination . Based on this consideration and both principles of endoluminal anatomy and recognized landmarks, a total of 28 unique endoluminal areas comprising the whole inner lining of the upper GI tract, from the hypopharynx to the second portion of the duodenum, have been described . Photographic registry of this mucosal framework constitutes the basis to achieve complete photodocumentation.…”

Linked color imaging improves the endoscopic visibility of gastric mucosal cancers

“…Failure to detect early gastric cancer during endoscopy may contribute to poor prognosis 21 . Thus, a variety of premedication and screening techniques are available to ensure the quality of EGD 24 25 . When the distribution of scores was analyzed in our study, the rate of poor visibility of LCI mode was lower than that of WLI.…”