Optimal number of images and 2-year interval affect cancer detection in screening esophagogastroduodenoscopy - An observational study

Q: What was the primary goal of the study on screening EGD?

To identify quality indicators for esophagogastroduodenoscopy that improve detection of upper gastrointestinal (UGI) cancer.

Q: How were endoscopists classified for analysis?

They were classified into fast/slow groups based on mean examination time for normal findings during the first year, and into small/large groups based on the number of endoscopic images.

Q: What interval effect did repeated endoscopy show within 2 years?

Repeated endoscopy within 2 years produced a higher overall cancer detection rate compared with repeated screening after 2 years.

Sep 21, 2026

Uploaded by River Wang

The study identified quality indicators for esophagogastroduodenoscopy (EGD) to detect upper gastrointestinal (UGI) cancer using retrospective data from 43,526 consecutive health checkups (August 2012–January 2022). After selection, 42,387 examinations by 12 high-volume endoscopists were analyzed. Endoscopists were grouped by examination time (fast/slow) and by number of images (small/large), with 5 minutes or 50 images as cutoffs. Faster and fewer-image observations were linked to lower overall UGI cancer detection, while repeated endoscopy within 2 years increased detection. Sub-analyses showed a negative association between gastric cancer detection and gastric images <35, and a trend for pharyngeal and esophageal cancers with esophageal images <11.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Aim and rationale for EGD quality indicators

Background on missed UGI cancers and existing standards

Study design and methods

Data source and inclusion of examinations

Endoscopist grouping by time and image number

Outcomes and statistical analysis

Results

Detection rates by time/image groups

Multivariable associations

Impact of repeated screening interval

Sub-analysis for gastric, pharyngeal, and esophageal cancers

® Observational Study Optimal number of images and 2-year interval affect cancer detection in screening esophagogastroduodenoscopy An observational study Kazuhiro Kashiwagi, MDa ,b ,* , Toshifumi Yoshida, MDa , Kayoko Fukuhara, MDa , Rieko Bessho, MDa , Hitoshi Ichikawa, MDa , Nagamu Inoue, MDa , Hiromasa Takaishi, MDa , Yasushi Iwao, MDa , Takanori Kanai, MDc | Abstract
We aimed to identify quality indicator for esophagogastroduodenoscopy for detecting upper gastrointestinal (UGI) cancer. Data from 43,526 consecutive health checkups from August 2012 to January 2022 were retrospectively collected. The study ultimately analyzed 42,387 examinations by 12 endoscopists who performed more than 1000 examinations, including all cancers detected. These endoscopists were classified either into fast/slow group based on their mean examination time for a normal finding of esophagogastroduodenoscopy during their first year of the examination, or small/large group based on number of endoscopic images, respectively. The association between UGI cancer detection rate and examination time or the number of images was analyzed, using 5 minutes or 50 images as cutoff values. The detection rate of overall (8 pharyngeal, 39 esophageal, 69 gastric) cancers in the fast, slow, small, and large groups were 0 . 17%, 0.32%, 0.21%, and 0.31%, respectively. On multivariable analysis, endoscopists in the fast group or the small group were less likely to detect overall UGI cancer (OR: 0.596, 95% CI: 0.373–0.952, P = .030; OR: 0.652, 95% CI: 0.434–0.979, P = .039) . Additionally, repeated endoscopy within 2 years had a higher overall cancer detection rate, compared with repeated screening after 2 years. In a sub-analysis, a significant negative relationship was found between the detection rate of gastric cancer and the number of gastric images < 35 (OR: 0.305, 95% CI: 0.189–0.492, P = .000) . There was also a negative correlation trend between the detection rate of pharyngeal and esophageal cancers and the number of esophageal images < 11 (OR: 0.395, 95% CI: 0.156–1.001, P = .050) . The optimal number of images and screening 2-year interval are considered useful quality indicators for detecting UGI cancer. This study also suggests that a total of 50 images, or 35 images of the stomach are suitable for detecting UGI cancer, or gastric cancer, during screening endoscopy. | | --- | | Abbreviations: BLI = blue light imaging, EGD = esophagogastroduodenoscopy, IEE = image-enhanced endoscopy, NBI = narrow band imaging, UGI = upper gastrointestinal. | | Keywords: examination time, number of endoscopic images, screening esophagogastroduodenoscopy, upper gastrointestinal cancer | 1. Introduction Esophagogastroduodenoscopy (EGD) is widely performed for early detection of cancers as well as nonlesions in the upper gastrointestinal (UGI) tract. The Korean national cancer screening program demonstrated the effect of endoscopic screening on gastric cancer mortality.[1] However, the missing rate for UGI cancers on routine EGD has been reported to vary between 9% and 20%.[2–6] Moreover, according to a Japanese large-scale survey[7] complied 46,529 patients with esophageal cancer experienced at 409 facilities, only 538 (1.2%) patients were detected through health screening program. Therefore, quality indicator The authors have no funding and conflicts of interest to disclose. All data generated or analyzed during this study are included in this published article [and its supplementary information files]. a Center for Preventive Medicine, Keio University, Tokyo, Japan, b Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, School of Medicine, Keio University, Tokyo, Japan, c Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan. * Correspondence: Kazuhiro Kashiwagi, Center for Preventive Medicine, Keio University, \#7 Azabudai Hills Mori JP Tower, 1-3-1 Az

FAQs

What was the primary goal of the study on screening EGD?

To identify quality indicators for esophagogastroduodenoscopy that improve detection of upper gastrointestinal (UGI) cancer.

How were endoscopists classified for analysis?

They were classified into fast/slow groups based on mean examination time for normal findings during the first year, and into small/large groups based on the number of endoscopic images.

What interval effect did repeated endoscopy show within 2 years?

Repeated endoscopy within 2 years produced a higher overall cancer detection rate compared with repeated screening after 2 years.

Sep 21, 2026

Uploaded by River Wang