背景:漏诊早期胃癌(MEGC)在食管胃十二指肠镜检查(EGD)期间普遍存在,这是检测早期胃癌(EGC)的一线推荐策略。因此,我们探讨了MEGC和不同类型MEGC的风险因素,基于内窥镜切除的人群。
方法:本回顾性研究,病例对照研究在南京鼓楼医院(NJDTH)进行。我们纳入了在筛查EGD期间被诊断为EGC的患者,进行了内镜切除术,并于2014年1月至2021年12月在NJDTH经术后病理证实,并根据漏诊的根本原因不同将其分为不同类型。单变量,多变量,亚组和倾向评分分析用于探索MEGC和不同类型MEGC的危险因素.
结果:共有447名患者,包括345例最初检测到的早期胃癌(IDEGC)和102例MEGC,包括在这项研究中。较大大小(≥1cm)(OR0.45,95%CI0.27-0.74,P=0.002)和粘膜下层浸润深度(OR0.26,95%CI0.10-0.69,P=0.007)与MEGC呈负相关。使用镇静(OR0.32,95%CI0.20-0.52,P<0.001)和更长的观察时间(OR0.60,95%CI0.37-0.96,P=0.034)对MEGC具有保护作用。
结论:较小和更浅表的EGC病变更容易误诊。在EGD期间使用镇静和延长观察时间有助于减少MEGC的发生。
BACKGROUND: Missed early gastric cancer (MEGC) is prevalent during esophagogastroduodenoscopy (EGD), which is the first-line recommended strategy for detecting early gastric cancer (EGC). Hence, we explored the risk factors for MEGC and different types of MEGC, based on the endoscopic resected population.
METHODS: This retrospective, case-control study was conducted at Nanjing Drum Tower Hospital (NJDTH). We included patients who were diagnosed with EGC during screening EGD, underwent endoscopic resection, and were confirmed by postoperative pathology at the NJDTH from January 2014 to December 2021, and classified them into different types according to the different root causes of misses. Univariable, multivariable, subgroup and propensity score analyses were used to explore the risk factors for MEGC and different types of MEGC.
RESULTS: A total of 447 patients, comprising 345 with initially detected early gastric cancer (IDEGC) and 102 with MEGC, were included in this study. Larger size (≥ 1 cm) (OR 0.45, 95% CI 0.27-0.74, P = 0.002) and invasion depth of submucosa (OR 0.26, 95% CI 0.10-0.69, P = 0.007) were negatively associated with MEGC. Use of sedation (OR 0.32, 95% CI 0.20-0.52, P < 0.001) and longer observation time (OR 0.60, 95% CI 0.37-0.96, P = 0.034) exhibited protective effect on MEGC.
CONCLUSIONS: Smaller and more superficial EGC lesions are more susceptible to
misdiagnosis. The use of sedation and prolonged observation time during EGD could help reduce the occurrence of MEGC.