Improving Efficacy of Endoscopic Diagnosis of Early Gastric Cancer: Gaps to Overcome from the Real-World Practice in Vietnam

Abstract

Objective. To identify factors associated with increased proportion of early gastric cancer to total detected gastric cancer among patients undergoing diagnostic esophagogastroduodenoscopy. Methods. A nationwide survey was conducted across 6 central-type and 6 municipal-type Vietnamese hospitals. A questionnaire regarding annual esophagogastroduodenoscopy volume, esophagogastroduodenoscopy preparation, the use of image-enhanced endoscopy, and number of gastric cancer diagnosed in 2018 was sent to each hospital. Results. The total proportion of early gastric cancer was 4.0% (115/2857). Routine preparation with simethicone and the use of image-enhanced endoscopy were associated with higher proportion of early gastric cancer (OR 1.9, 95% CI: 1.1–3.2, p=0.016; OR 2.7, 95% CI: 1.8–4.0, p<0.001, respectively). Esophagogastroduodenoscopies performed at central-type hospitals were associated with higher proportion of early gastric cancer (OR 1.9, 95% CI: 1.1–3.2, p=0.017). Esophagogastroduodenoscopies performed at hospitals with an annual volume of 30.000–60.000 were associated with higher proportion of early gastric cancer than those performed at hospitals with an annual volume of 10.000-<30.000 (OR 2.7, 95% CI: 1.6–4.8, p<0.001) and with a volume of >60.000–100.000 (OR 2.7, 95% CI: 1.7–4.2, p<0.001). Only four (33.3%) hospitals reported all endoscopic types of early gastric cancer. Conclusions. The detection of early gastric cancer is still challenging even for endoscopists working in regions with relatively high prevalence. The real-world evidence showed that endoscopic detection of early gastric cancer could potentially improve with simple adjustments of esophagogastroduodenoscopy protocols.

20-Year Trends in Detection Rates of Cardia Cancer via Endoscopic Surveillance in Tianjin, China: A Hospital-Based Study

“…The ability to detect early stage cancer during routine medical services is crucial, as it is the key to reducing gastric cancer-related mortality and improving patient survival times. Many factors can influence the diagnosis of early gastric cancer, including routine preparation before examination, type of endoscopy, use of image-enhanced endoscopy, procedure time, and alertness of endoscopists to early gastric cancer [ 26 – 28 ]. To reduce missed diagnoses, observation of the cardia subsite should be strengthened during endoscopic examination.…”

Prevalence, endoscopic and histopathological characteristics of early gastric cancer in Vietnamese patients

“…Several factors associated with the low efficacy of endoscopic diagnosis of EGC in Vietnam included no routine preparation with mucolytic and defoaming agents before EGD and no routine use of IEE during the procedure [12]. In addition, a national multicenter study revealed that EGDs performed at hospitals with an annual EGD volume of < 30,000 or > 60,000 procedures were associated with a lower proportion of EGC detected compared with those performed at hospitals with an annual EGD volume of 30,000-60,000 [12]. These observations could result from the different experiences and workloads of endoscopists.…”

Detection and Characterization of Early Gastric Cancer

“…A high-quality examination during an upper gastrointestinal endoscopy requires optimal mucosal visualization (1,2,15). The use of mucolytic and defoaming agents, such as simethicone and N-acetylcysteine, improves the visibility of gastric mucosa compared to water and is associated with an increased rate of detection of early gastric cancer (15)(16)(17)(18)(19). Recommended in Japanese guidelines on endoscopic diagnosis of EGC but often overlooked in the west, the preparation of the upper gastrointestinal tract with a mucolytic agent 10 to 30 min before endoscopy is an inexpensive method, with a low frequency of adverse reactions/minimal patient burden, that can help obtain the optimal gastric cleanliness (1,15,20,21).…”