Summary of gastroscopy quality indicators applicable in clinical practice

Tips for improving the identification of neoplastic visible lesions in Barrett’s esophagus

Correlation of the detection rate of upper GI cancer with artificial intelligence score: results from a multicenter trial (with video)

Objective: To analyze the effect of iodine staining endoscopy in the screening of esophageal early cancer. Methods: The clinical data of people who underwent gastroscopy from January 1, 2019 to December 31, 2023 in Xuyi People's Hospital affiliated to Kangda College of Nanjing Medical University were retrospectively analyzed. According to whether the esophagus was stained with Lugo's iodine solution, the patients were divided into iodine staining group (Lugo's iodine solution staining) and non-iodine staining group. According to the years of operation, endoscopists were divided into less experienced endoscopists (<10 years) and experienced endoscopists (≥10 years). The basic characteristics of the patients in the iodine staining group and the non-iodine staining group were compared, and the differences in the detection rates of low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN) and early esophageal cancer among endoscopists with iodine staining and different years of experience were compared. Results: A total of 9 918 patients were enrolled, including 4 564 males and 5 354 females, with age of (57.3±7.3) years. There were 4 965 cases [2 312 males and 2 653 females, aged (57.4±7.4) years] in the non-iodine staining group. There were 4 953 patients [2 252 males and 2 701 females, aged (57.2±7.2) years] in the iodine staining group. There was no significant difference in sex and age between the two groups (both P>0.05). The detection rate of esophageal LGIN [0.3% (5/4 965) vs 3.2% (159/4 953)], the detection rate of HGIN [0.2% (10/4 965) vs 0.7% (32/4 953)] and the detection rate of early case [0.2% (12/4 965) vs 0.7% (35/4 956)] in the non-iodine staining group were lower than those in the iodine staining group (all P<0.001). There was no significant difference in the detection rate of early esophageal cancer between the two groups [0.0% (2/4 965) vs 0.1% (3/4 953), P>0.05]. In the non-iodine staining group, the detection rate of esophageal LGIN [0.6% (12/1 991) vs 0.1% (3/2 974)], the detection rate of HGIN [0.4% (8/1 991) vs 0.1% (2/2 974)], the detection rate of early case [0.5% (9/1 991) vs 0.1% (3/2 974)], and the positive rate of biopsy [35.3% (9/1 991) vs 13.6% (30/2 974)] in the experienced endoscopists were all higher than those of the less experienced endoscopists (all P<0.05). There was no significant difference in the detection rate of early-stage esophageal cancer between the two groups [0.0% (1/2 974) vs 0.1% (1/1 991), P=0.279]. In the iodine staining group, there were no statistical difference in the detection rates of LGIN, HGIN, early-stage esophageal cancer and early cases between the experienced endoscopists and the less experienced endoscopists (all P>0.05). Conclusion: Iodine staining endoscopy can improve the detection rate of early esophageal cancer and precancerous lesions, especially for less experienced endoscopists.

The influence of sedation on the endoscopic detection rate of upper gastrointestinal (UGI) early cancer (EC) and precancerous lesions, including high-grade intraepithelial neoplasia (HGIN) and low-grade intraepithelial neoplasia, has not been assessed. The aim of this research is to assess whether the use of sedation can help improve the detection rate of UGI EC and precancerous lesions. The second objective is to evaluate its potential influencing factors. The study includes 432,202 patients from a multicenter database from January 2012 to July 2019. Information on endoscopic findings and histology biopsies was obtained from endoscopy quality-control system. Associations of sedation with the detection rate of EC and precancerous lesions were assessed. The sedation group has a higher detection rate of UGI EC and HGIN compared with the no-sedation group, whereas the detection rate of low-grade intraepithelial neoplasia was similar between the 2 groups. There were more cases examined by using staining, image enhancement, or magnifying techniques in the sedation group (P < 0.001). And, the mean observation time was also longer in the sedation group (P < 0.001). The type 0-IIb esophageal HGIN and EC cases were significantly increased in the sedation group. No significant difference was detected on lesion subtypes for gastric HGIN and EC according to the Paris classification. More gastric HGIN and EC were detected at gastric body in the sedation group (P = 0.001). Sedation may improve the endoscopic detection rate of EC and HGIN in the UGI tract probably through enhancing the use of accessary endoscopic techniques, prolonging observation time, and taking more biopsies in different locations (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/AJG/B926).

Objective: To understand the incidence of esophageal cancer in population at high risk in Yangzhong of Jiangsu province. Methods: Cluster random sampling method was conducted to select several natural villages from the high risk area of esophageal cancer in Yangzhong during 2011-2017. Local residents aged 40-69 years were selected as the target population and a total of 14 687 persons were diagnosed esophageal cancer by endoscopy and pathology. Results: Precancerous lesions were detected in 341 persons, with the detection rate as 2.32% (341/14 687). Among them, there were 234 (1.59%) cases with mild and 107 (0.73%) cases with moderate esophageal hyperplasia. There were 77 positive cases with esophageal hyperplasia and the detection rate was 0.52%. Among these positive cases, 41 showed severe esophageal hyperplasia/carcinoma in situ (0.28%), with another 19 as early esophageal cancer (0.13%) and 17 with invasive carcinoma (0.12%). The overall early detection rate of positivity through active screening was 77.92% (60/77), with trends of upwarding and then downwarding. The detection rate of esophageal lesions in men was higher than that in women (P<0.05), but without significant gender specific differences seen in the detection rates of early esophageal cancer or invasive carcinoma (P>0.05). The detection rates of all lesions other than invasive carcinoma, gradually increased with age (P<0.05). The detection rate of invasive carcinoma reached the highest (0.39%, 10/2 547) in the age group of 60-years and slightly decreased in the age group of 65-years old. Conclusions: Considerable numbers of patients with cancer and precancerous lesions in groups at high-risk can be found through the screening program for esophageal cancer, suggesting that the screening program is of great significance in improving the survival rate and quality of life. Attention should be paid to men, with elderly groups in particular, at high-risk in order to increase the detection rate of early cases.

This study aimed to investigate the effectiveness of pronase in improving the detection rate of early cancer and enhancing visual field clarity during gastroscopy in China. In total, 1450 patients who participated in an early diagnosis and treatment programme of upper gastrointestinal cancer in Wuwei, Gansu Province between 2020 and 2021 were enrolled. Cluster randomisation was utilised at the community level. All patients underwent endoscopy and biopsy. The experimental group (n=725) received pronase granules and dimethicone prior to gastroscopy; the control group (n=725) received dimethicone alone. Endoscopic visibility scores, examination durations, and lesion detection rates were recorded for both groups. Visibility scores for all regions of the stomach were significantly lower in the experimental group than in the control group (P<0.001). This finding remained consistent after adjustment for confounding factors in multiple linear regression analysis. The detection rate of precancerous lesions and early cancer was significantly higher in the experimental group than in the control group (77.5% vs 62.5%; P<0.001). Binary logistic regression analysis indicated that the likelihood of detecting early cancer was greater in the experimental group, with an odds ratio of 3.840 (95% confidence interval=1.204-12.241; P=0.023). Also, average gastroscopy time was significantly shorter in the experimental group than in the control group (6.52±2.51 min vs 10.03±1.23 min, t=33.81; P=0.001). The administration of pronase prior to gastroscopy enhances visual field clarity, reduces examination time, and increases the detection rates of precancerous lesions and early cancer.

Adjusting Detection Measures for Colonoscopy: How Far Should We Go?

BackgroundPremedication in upper gastrointestinal endoscopy for higher lesions detection rate has not been well studied so far. This study aimed to confirm whether premedication could improve the detection rate of early cancer or precancerous lesions and mucosal visibility.MethodFrom July 2015 to December 2015, 7200 participants from 6 centers were screened by endoscopy with one of the 4 following premedications randomly: (1) water (group D); (2) pronase (group A); (3) simethicone (group B); (4) pronase and simethicone (group C). Early cancer and precancerous lesions detection rates were taken as the primary endpoints, and mucosal visibility was taken as the secondary endpoint. They were compared among four groups to determine different premedication effects in terms of different anatomical sites. Trial was registered at Chinese Clinical Trial Registry; the registration number is ChiCTR-IOR-17010985.ResultsThe upper gastrointestinal overall precancerous lesion detection rates among four groups were 8.7, 8.4, 10.0, and 10.3%, the overall early cancer detection rates were 1.3, 1.4%, 1.5, and 1.6%, both without significant difference (p = 0.138 and 0.878). However, the visibility score distributions between control group (D) and premedication groups (A, B, and C) were all statistically significant, with all anatomical sites p values < 0.001. Subgroup analyses, from 2 centers without screening before, also showed significant difference in esophageal (3.9, 3.3, 4.5, and 8.4% with p = 0.004) and overall (7.0, 5.5, 7.3, and 12.0% with p = 0.004) precancerous lesion detection rate.ConclusionsPremedication with pronase and simethicone may not increase lesion detection rates but could significantly increase the upper gastrointestinal mucosal visibility.

Objective To evaluate the application value of quantitative immune fecal occult blood test (FOBT) in colonoscopy for the screening of colorectal cancer in health check-up participants. Methods The subjects were selected from July 2017 to June 2018 in the Health Management Center of the Second Affiliated Hospital of Suzhou University. The subjects were the healthy individuals who chose quantitative immune or chemical method plus immunogold (referred to as double-method FOBT ), excluding those who had interfering factors. Individuals with a positive result in primary screening were selected and conducted with colorectal cancer by colonoscopy. If the polyploidy lesions were observed during colonoscopy, the biopsy or excision was performed, and the pathological diagnosis was performed. The positive rate of primary screening, compliance rate of colonoscopy and pathological results of colonoscopy were compared between the two methods. Quantitative immunoassay was analyzed in different gender, age group, physical examination nature, positive rate of primary screening, compliance rate of colonoscopy and pathological results of colonoscopy. Results 18 728 people chose quantitative immunoassay and 6 212 people chose at the same time. There was no significant difference in gender and age between the two groups (all P>0.05), which was comparable. The detection rate of quantitative immune was higher than (74.62% vs 32.23%, P<0.001). The positive rate of quantitative immune in primary screening was lower than (4.11% vs 5.34%, P=0.003). The colonoscopy screening rate in positive population by quantitative immune was higher than (27.83% vs 13.08%, P=0.001). These differences were statistically significant. The detection rate of total lesions by colonoscopy was 71.88% in positive population by quantitative immune FOBT. It was 42.86% in FOBT. There was no statistical difference between the two methods (P=0.05). The detection rates of quantitative immune were significantly different among different genders, ages and physical properties (all P<0.001). The detection rate was higher in males than in females (79.14% vs 68.75%). The detection rate was highest in the group between 40 and 59 years old (79.96%). The individual detection rate was higher than the group (90.08% vs 66.07%). The positive rates in primary screening were significantly different among different ages (P=0.001).It was highest in the group aged 60 or above (5.59%). The colonoscopy screening rate in positive population by quantitative immune was highest in the group aged 50 or above (36.96%). The detection rate of inflammatory lesions were significantly different among different ages (P<0.001). The detection rate of colorectal cancer in males was higher than in females (11.11% vs 0.00%, P=0.009). In addition, with the increasing of fecal occult blood value, the detection rate of cancer was increased (P=0.041). Conclusion The quantitative immune is an ideal non-invasive examination for early screening of colorectal cancer. It has important application values. Key words: Quantitative; Fecal occult blood test; Colorectal tumor; Physical examination; Enteroscope

Esophagogastroduodenoscopy (EGD) screening is vital for the early diagnosis of esophageal squamous cell cancer (ESCC). However, improvement in the detection rate of precancerous lesions and early ESCC with anesthesia assistance (AA) has not yet been investigated. This retrospective study aimed to evaluate the effect of AA on the detection rate of precancerous lesions and early ESCC in patients undergoing EGD screening and identify risk factors affecting the detection rate. We reviewed patients' electronic medical records who underwent EGD screening between May 2019 and August 2020. Patients were divided into two groups based on whether they received AA: those in Group A underwent EGD screening with AA, and patients in Group O underwent EGD screening without AA. Propensity score matching (PSM) was used to account for differences in baseline characteristics. Detection rates of precancerous lesions and early ESCC were compared between the two groups following PSM. Binary logistic regression was used to identify risk factors affecting the detection rate. The final analysis included 21,835 patients (Group A = 13,319, Group O = 8,516) from 28,985 patients who underwent EGD screening during the study period. Following PSM, 6009 patients remained in each group for analysis. There was no significant difference in the detection rate of precancerous lesions and early ESCC between Groups A and O (1.1% vs. 0.8%, p > 0.05). Binary logistic regression showed that age (50-59 years, 60-69 years and 70-79 years), higher endoscopist seniority, high-definition (HD) endoscopy, narrow-band imaging (NBI), and number of endoscopic images were all independent risk factors that affected the detection rate of precancerous lesions and early ESCC. There was no statistically significant difference in the detection rate of precancerous lesions and early ESCC between patients who underwent EGD screening with and without AA. All independent risk factors that affected the detection rate of precancerous lesions and early ESCC included the following: age (50-59 years, 60-69 years and 70-79 years), higher endoscopist seniority, HD endoscopy, NBI, and number of endoscopic images. Endoscopists should consider all these factors as much as possible when performing EGD screening.

To analyze the effect of streptomyces protease combined with dyclonine in painless magnifying endoscopy. A total of 100 patients who underwent magnification endoscopy in our hospital from January 2021 to June 2022 were retrospectively analyzed. The diagnoses were made by painless magnifying endoscopy and narrow-band imaging combined with pathological findings. The patients were divided into the observation group and control group, the observation group was streptomyces protease combined with dyclonine group, and the control group was dyclonine group, 50 cases in each group. The visibility score under gastroscopy was compared between the 2 groups, and the morphological classification of gastric pit and collecting veins was observed. The detection rates of small lesions and early cancer were compared between the 2 groups. The examination time and adverse reactions were compared between the 2 groups. Compared with the control group, the streptomyces protease combined with dyclonine group had better clear visibility and a higher detection rate of small lesions, but there was no significant difference in early cancer detection rate between the 2 groups. The examination time of streptomyces protease combined with dyclonine group was relatively prolonged, but there was no significant difference in the incidence of adverse reactions between the 2 groups. Streptomyces protease combined with dyclonine plays a certain role in painless magnifying gastroscopy, which can improve the visibility of gastroscopy, improve the detection rate of small lesions, help to find gastric dysplasia and early gastric cancer diagnosis, and does not increase the incidence of adverse reactions.

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

P299 A prospective randomised trial comparing dye-based chromoendoscopy with electronic virtual chromoendoscopy for detection of colonic neoplastic lesions during IBD surveillance colonoscopy

To construct key quality indicators for aged care facilities in China. Evaluating the care quality in aged care facilities is problematic. Evaluation of nursing care quality is important for improving nursing and self-supervision in aged care facilities. However, a few regulations and studies regarding care quality evaluation have been implemented in China. This two-tier Delphi study aimed to achieve consensus on key quality indicators for aged care facilities in China. The entry pool was determined by literature review and research team discussion, followed by a discussion by a panel of experts to establish the items of the Delphi study. Finally, key care quality indicators were established through a two-round Delphi study. This study followed the SQUIRE 2.0 guidelines. The initial 16 quality indicators of the entry pool was developed based on a literature review and a group discussion. Sixteen quality indicators were reduced to eight after the expert discussion. After two rounds of expert consultation, the eight quality indicators became nine, which were then evaluated for importance, formula rationality, and operability using Kendall's harmony coefficients (first round: 0.150, 0.143 and 0.169, respectively; second round: 0.209, 0.159 and 0.173, respectively). Key quality indicators provide quantifiable evidence for evaluating the care quality in aged care facilities, but their applicability needs continuous improvement. Nine key quality indicators were selected from numerous indicators for measuring the care quality in aged care facilities, supporting the evaluation of the care quality and self-supervision for aged care facilities. No elderly or public contribution.

IntroductionAmong opportunistically screened population with above normal-weight, screening-related information remains limited. This study aimed to evaluate the infection status and distribution of high-risk (hr) human papillomavirus (HPV) on precancerous grades and cancer among overweight women compared with normal-weight women, and further explored the association between clinical characteristics and both HPV infection and cervical lesions.MethodsThe reporting of this cross-sectional retrospective study conforms to STROBE guidelines. This study was conducted in the Affiliated Cancer Hospital of Xinjiang Medical University. A total of 720 out of 1146 women with complete medical records of demographic and clinical characteristics were enrolled on the colposcopy clinic. HrHPV infection status, cytology abnormality rates, detection rates of cervical intraepithelial neoplasia (CIN) grades and cancer, and clinical performance of triage tests were evaluated by Body Mass Index (BMI) levels, which were classified into two groups as overweight women (BMI ≥24kg/m2) and normal-weight women (BMI <24kg/m2).ResultsThe hrHPV infection rate of overweight women (73.0%) was not significantly lower than that of normal-weight women (78.6%) by the GenoArray test (P = 0.09) and by HC2 test (68.5% vs 71.0%, P = 0.53). The positive rates of most frequent hrHPV subtypes of overweight women vs normal-weight women were HPV16 (31.1% vs 39.1%, P = 0.03). The detection rates of CIN lesions were lower among overweight vs normal-weight (28.3% vs 37.4%, P = 0.01), while the detections rate of cancer was slightly higher but not significant (7.2% vs 4.6%, P = 0.14). The clinical performance of different screening strategies were similar between overweight and normal weight women.ConclusionsThe HPV16 prevalence and the detection rate of cervical precancerous lesions was lower in overweight women than normal-weight women, indicating that targeted management strategies should be given to overweight women to decrease the underdiagnosis.