■胃腺瘤的早期发现和治疗对于预防胃癌很重要。本研究旨在评估韩国内镜检查中漏诊胃腺瘤的预测因素,并确定与间期胃癌前病变相关的危险因素。
■回顾了2007年至2019年通过筛查内镜诊断出的所有胃腺瘤病例。其中,在3年内接受内窥镜检查的患者被纳入本研究.漏诊胃腺瘤定义为在内镜检查阴性后3年内诊断出的胃腺瘤。
■总共,共发现胃腺瘤295例。其中,95例(32.2%)漏诊胃腺瘤(平均年龄,60.6年;最终内窥镜检查和指数内窥镜检查之间的平均间隔,12.6个月);其余200例(67.8%)为新检出腺瘤病例。单因素分析显示男性,内窥镜经验,观察时间,胃肠上皮化生的存在(经病理证实)与胃腺瘤的遗漏有关。多因素分析显示胃肠上皮化生(比值比[OR],2.736;95%置信区间[CI],1.320-5.667;P=0.007)和较短的指标筛查内镜观察时间(B,-0.011;或,0.990;95%CI,0.986-0.993;P<0.001)是胃腺瘤漏诊的独立危险因素。检测胃腺瘤的最佳观察时间为3.53分钟(曲线下面积,0.738;95%CI,0.677-0.799;P<0.001)。
■胃肠上皮化生是胃腺瘤漏诊的指征。因此,仔细检查胃粘膜伴胃肠上皮化生,适当的观察时间可降低筛查时漏诊胃腺瘤的可能性。
UNASSIGNED: Early detection and management of gastric adenoma are important for preventing gastric cancer. The present study aimed to evaluate the predictors of missed gastric adenoma on screening endoscopy in Korea and identify the risk factors associated with interval precancerous gastric lesions.
UNASSIGNED: All cases of gastric adenomas diagnosed via screening endoscopy between 2007 and 2019 were reviewed. Among them, those who had undergone endoscopy within 3 years were included in the present study. Missed gastric adenoma was defined as gastric adenoma diagnosed within 3 years after negative screening endoscopy.
UNASSIGNED: In total, 295 cases of gastric adenoma were identified. Of these, 95 (32.2%) were missed gastric adenoma cases (mean age, 60.6 years; average interval between final and index endoscopies, 12.6 months); the remaining 200 (67.8%) were newly detected adenoma cases. Univariate analysis revealed that male sex, endoscopist experience, observation time, and presence of gastric intestinal metaplasia (pathologically proven) were associated with missed gastric adenoma. Multivariate analysis revealed that gastric intestinal metaplasia (odds ratio [OR], 2.736; 95% confidence interval [CI], 1.320-5.667; P = 0.007) and shorter observation time of the index screening endoscopy (B, -0.011; OR, 0.990; 95% CI, 0.986-0.993; P < 0.001) were independent risk factors for missed gastric adenoma. The optimal cut-off for the observation time for detecting gastric adenoma was 3.53 minutes (area under curve, 0.738; 95% CI, 0.677-0.799; P < 0.001).
UNASSIGNED: Gastric intestinal metaplasia is an indication of missed gastric adenoma. Therefore, careful inspection of gastric mucosa with gastric intestinal metaplasia and proper observation time can lower the possibility of missing the gastric adenoma during screening.