Clin Endosc.  2017 Sep;50(5):473-478. 10.5946/ce.2016.143.

Can Endoscopic Ulcerations in Early Gastric Cancer Be Clearly Defined before Endoscopic Resection? A Survey among Endoscopists

• Park SM
• Kim BW
• Kim JS
• Kim YW
• Kim GJ
• Ryu SJ

• KMID: 2394747
• DOI: http://doi.org/10.5946/ce.2016.143

Abstract

BACKGROUND/AIMS
Early gastric cancer (EGC) with ulcerations can be treated via endoscopic resection (ER) when it is differentiated pathologically, limited to the mucosa, and <3 cm in diameter. The presence of ulceration is a key factor in deciding treatment strategies and is usually diagnosed during endoscopic examination. The aim of this study was to evaluate whether ulcerations in EGC can be clearly defined among endoscopists and which factors are related to the differences.
METHODS
A survey questionnaire, composed of demographic features and endoscopic images of seven patients with EGC, was presented to the endoscopists via e-mail. The endoscopists were asked whether such patients have ulcerations in the lesions.
RESULTS
The questionnaires were e-mailed to 197 endoscopists, and 103 doctors replied. The presence of an endoscopic ulceration was defined differently among the endoscopists, depending on the duration of endoscopic practice and the experience of endoscopic submucosal dissection. The differences were especially high in the lesions without mucosal breaks and converging folds, which were expected to be viewed as non-ulcerative.
CONCLUSIONS
Before ER, endoscopic ulcerations in EGC must be reviewed by experienced endoscopists to reduce overestimations, and adequate educational programs for trainees should be established.

Keyword

Stomach neoplasms; Endoscopic resection; Ulcer; Surveys and questionnaires

MeSH Terms

Electronic Mail
Humans
Mucous Membrane
Stomach Neoplasms*
Surveys and Questionnaires
Ulcer*

Figure

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  Fig. 1. Seven endoscopic images used in the present survey. (A) Deep mucosal break without converging folds. (B) Mucosal break with converging folds. (C) Shallow mucosal break without converging folds. (D) Depressed lesion without mucosal break and converging folds. (E) Depressed lesion without mucosal break with converging folds. (F) Elevated lesion without mucosal break and converging folds and (G) Depressed lesion with sharply demarcated and raised margins with mucosal break and no converging folds.

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  Fig. 2. Diagnostic rates of endoscopic ulceration in each endoscopic image.

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  Fig. 3. Comparison of the diagnostic rates of endoscopic ulceration in each endoscopic image. (A) endoscopic experience, <5 years vs. ≥5 years. (B) Endoscopic submucosal dissection experience, none vs. yes.

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