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.