title: When do we miss synchronous gastric neoplasms with endoscopy?
abstract: BACKGROUND
  Accurate detection of synchronous multifocal gastric cancer is mandatory for the successful management of stomach cancer.
  
  
  OBJECTIVE
  We compared the sensitivities of gastroscopy and the current criterion standard of surgical resection and investigated the risk factors involved when clinicians fail to recognize additional gastric lesions.
  
  
  METHODS
  We performed a retrospective examination of the clinicopathological features of synchronous multifocal gastric carcinoma in a recent sample of gastrectomy patients.
  
  
  METHODS
  In this study, we enrolled a total of 51 patients (5.17%) with synchronous multifocal gastric carcinoma who had undergone gastrectomy between 2005 and 2008. During that time, 80.43% of patients who had multifocal lesions underwent gastric resection.
  
  
  METHODS
  We compared preoperative gastroscopic findings with surgically resected stomach specimens.
  
  
  RESULTS
  Synchronous multifocal gastric carcinoma was more frequent in older patients, males, and those with early gastric cancer. Using upper endoscopy, we missed accessory lesions in 14 (27.5%) of 51 patients. A total of 109 lesions were present in the resected stomachs, and upper endoscopy detected 93 of these (85.3% sensitivity). Thus, 16 lesions (14.67%) were missed out of a total of 109 gastric lesions. We found that small lesion size was the major risk factor for endoscopic failure to recognize additional lesions.
  
  
  CONCLUSIONS
  Our study sample was small, and a large-scale study exploring these risk factors is warranted. Most of the study sample (80.39%) underwent subtotal gastrectomy; therefore, whole-stomach pathology could not be evaluated. Because early gastric cancer has a higher likelihood of being treated by EMR without surgery, there can be problems associated with reliance on surgical specimens. The findings of this study might have been affected by the higher rate of gastric cancers seen in East Asians.
  
  
  CONCLUSIONS
  The entire stomach should be examined with particular care during endoscopy procedures, especially when endoscopic resections of tumors are to be performed. Further, to improve detection, the approaches used to evaluate patients for multifocal tumors need to be improved. A large-scale prospective study is necessary to follow up on our findings.
authors.affiliation: Department of Internal Medicine, Hanyang University Hospital, 133-070, Seoul, Korea.
authors.forename: Hang Lak
authors.initials: HL
authors.lastname: Lee
authors.forename: Chang Soo
authors.initials: CS
authors.lastname: Eun
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Lee
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Han
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Yoon
authors.forename: Ho Soon
authors.initials: HS
authors.lastname: Choi
authors.forename: Joon Soo
authors.initials: JS
authors.lastname: Hahm
authors.forename: Dong Hee
authors.initials: DH
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery