Introduction
Detecting gastric precancerous lesions (GPLs) is critical for the early diagnosis and treatment of gastric cancer (GC). Endoscopy combined with tissue examination is an important method for detecting GPLs. However, negative biopsy results often increase patients' risks, economic burdens, and lead to additional healthcare costs(1). Improving the detection rate of gastric precancerous lesions and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.
Aims & Methods
To explore the relationships among the endoscopist biopsy rate (EBR), qualifications of endoscopists and endoscopic assistants, and detection rate of GPLs. EBR, endoscopists, and endoscopic assistants were divided into four groups: low, moderate, high, and very high levels. Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions. Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR, endoscopist or endoscopic assistant qualifications, and the detection rate of positive lesions.
Results
Compared with those in the low EBR group, the OR values for detecting positive lesions in the moderate, high, and very high EBR groups were 1.12 (95% CI 1.06–1.19, P<0.001), 1.22 (95% CI 1.14–1.31, P<0.001), and 1.38 (95% CI 1.29–1.47, P<0.001), respectively. EBR was positively correlated with the detection rate of gastric precancerous conditions (GPCs, atrophic gastritis/intestinal metaplasia) (ρ=0.465, P=0.004). In contrast, the qualifications of the endoscopists were positively correlated with gastric precancerous lesions(GPLs) detection(ρ=0.448, P=0.005). Compared with low-qualification endoscopists, those with moderate, high, and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13% (OR = 1.13, 95% CI: 0.98–1.31), 20% (OR = 1.20, 95% CI: 1.03–1.39), and 32% (OR = 1.32, 95% CI: 1.15–1.52), respectively. Further analysis revealed the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia (ρ=0.350, P=0.034), angularis (ρ=0.396, P=0.015) and gastric body (ρ=0.453, P=0.005) but not in the antrum ( ρ=0.292, P=0.079). Moreover, the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications (ρ=0.427, P=0.015).
Conclusion
High/very high qualification of endoscopists and endoscopic assistants, but not EBR, can improve the detection rate of gastric precancerous lesions. These results provide reliable evidence for the development of gastroscopic quality control indicators.
References
(1)Shi Y, Wei N, Wang K, Tao T, Yu F, Lv B. Diagnostic value of artificial intelligence-assisted endoscopy for chronic atrophic gastritis: a systematic review and meta-analysis. Front Med (Lausanne). 2023;10:1134980.
Disclosure
The authors declare that they have no conflict of interests.
