Original article
Clinical endoscopy
When do we miss synchronous gastric neoplasms with endoscopy?

https://doi.org/10.1016/j.gie.2010.01.011Get rights and content

Background

Accurate detection of synchronous multifocal gastric cancer is mandatory for the successful management of stomach cancer.

Objective

We compared the sensitivities of gastroscopy and the current criterion standard of surgical resection and investigated the risk factors involved when clinicians fail to recognize additional gastric lesions.

Design

We performed a retrospective examination of the clinicopathological features of synchronous multifocal gastric carcinoma in a recent sample of gastrectomy patients.

Patients

In this study, we enrolled a total of 51 patients (5.17%) with synchronous multifocal gastric carcinoma who had undergone gastrectomy between 2005 and 2008. During that time, 80.43% of patients who had multifocal lesions underwent gastric resection.

Main Outcome Measurements

We compared preoperative gastroscopic findings with surgically resected stomach specimens.

Results

Synchronous multifocal gastric carcinoma was more frequent in older patients, males, and those with early gastric cancer. Using upper endoscopy, we missed accessory lesions in 14 (27.5%) of 51 patients. A total of 109 lesions were present in the resected stomachs, and upper endoscopy detected 93 of these (85.3% sensitivity). Thus, 16 lesions (14.67%) were missed out of a total of 109 gastric lesions. We found that small lesion size was the major risk factor for endoscopic failure to recognize additional lesions.

Limitations

Our study sample was small, and a large-scale study exploring these risk factors is warranted. Most of the study sample (80.39%) underwent subtotal gastrectomy; therefore, whole-stomach pathology could not be evaluated. Because early gastric cancer has a higher likelihood of being treated by EMR without surgery, there can be problems associated with reliance on surgical specimens. The findings of this study might have been affected by the higher rate of gastric cancers seen in East Asians.

Conclusions

The entire stomach should be examined with particular care during endoscopy procedures, especially when endoscopic resections of tumors are to be performed. Further, to improve detection, the approaches used to evaluate patients for multifocal tumors need to be improved. A large-scale prospective study is necessary to follow up on our findings.

Section snippets

Materials and methods

Institutional review board approval was obtained before starting the study. This was a retrospective analysis of all patients who were diagnosed with synchronous multifocal gastric carcinomas after gastric resection surgery for cancer at Hanyang University Hospital between 2005 and 2008. All patients included in the sample underwent upper endoscopy before surgery. Preoperative upper endoscopy reports were drawn from the hospital's endoscopy database.

Cases were excluded if the endoscopist or

Baseline patient characteristics

Of 986 gastric cancer patients who underwent gastric resection at Hanyang University Hospital between January 2005 and September 2008, 51 (5.17%) cases of multifocal synchronous gastric cancer were diagnosed after surgical resection. During the study period, a total of 121 stomach cancer patients underwent an ESD or EMR procedure. Among 121 patients, 9 patients had multifocal lesions. Therefore, a total of 46 patients had multifocal lesions during the preoperative workup. Accordingly, 80.43% of

Discussion

In this study, we found that small lesion size was significantly correlated with the missed detection of accessory lesions. Even expert endoscopists can miss accessory lesions in as many as 27.5% of patients with synchronous multiple gastric carcinomas. Multiple synchronous gastric neoplasms were more frequently encountered in early gastric cancer.

Gastric cancer is the most common cause of cancer death in Korea.1, 2 Despite the improved prognosis of gastric cancer resulting from early

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This work was supported by the research fund of Hanyang University (HY-2009-N).

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