title: Longer examination time improves detection of gastric cancer during diagnostic upper gastrointestinal endoscopy.
abstract: OBJECTIVE
  It is not clear how the duration of upper endoscopy affects the detection of cancer or premalignant lesions that increase the risk for gastric cancer. We investigated whether the length of time spent performing esophagogastroduodenoscopy (EGD) affects the detection of important pathologic features of the stomach.
  
  
  METHODS
  We collected data from 837 symptomatic patients, during a 3-month period in 2010, who underwent a first diagnostic EGD at a tertiary university hospital in Singapore. Endoscopists were classified as fast or slow based on the mean amount of time it took them to perform a normal EGD examination. We used logistic regression to compare between groups the numbers of intestinal metaplasias, gastric atrophies, dysplasias, and cancers detected, using histologic analysis of biopsy samples collected during endoscopy as the standard.
  
  
  RESULTS
  Of 224 normal endoscopies, the mean duration was 6.6 minutes (range, 2-32 min). When we used 7 minutes as the cut-off time, 8 endoscopists were considered to have short mean examination times (mean duration, 5.5 ± 2.1 min; referred to as fast endoscopists), and 8 endoscopists were considered to have long mean examination times (mean duration, 8.6 ± 4.2 min; referred to as slow endoscopists). Eleven cancers and 81 lesions considered to pose risks for cancer were detected in 86 patients; 1.3% were determined to be cancer, 1.0% were determined to be dysplasia, and 8.7% were determined to be intestinal metaplasia and/or gastric atrophy. Slow endoscopists were twice as likely to detect high-risk lesions as fast endoscopists (odds ratio, 2.50; 95% confidence interval, 1.52-4.12), regardless of whether they were endoscopy staff or trainees. The slow endoscopists also detected 3-fold more neoplastic lesions (cancer or dysplasia; odds ratio, 3.42; 95% confidence interval, 1.25-10.38).
  
  
  CONCLUSIONS
  Endoscopists with mean EGD examination times longer than 7 minutes identified a greater number of high-risk gastric lesions than faster endoscopists. Examination time may be a useful indicator of quality assessment for upper endoscopy. Studies are required to test these findings in different populations.
authors.affiliation: Department of Surgery, National University Health System, National University of Singapore, Singapore.
authors.forename: Jun Liang
authors.initials: JL
authors.lastname: Teh
authors.affiliation: Department of Surgery, National University of Singapore, Singapore.
authors.forename: Jin Rong
authors.initials: JR
authors.lastname: Tan
authors.affiliation: Department of Surgery, National University of Singapore, Singapore.
authors.forename: Linus Jian Fa
authors.initials: LJ
authors.lastname: Lau
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Nakul
authors.initials: N
authors.lastname: Saxena
authors.affiliation: Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.
authors.forename: Agus
authors.initials: A
authors.lastname: Salim
authors.affiliation: Department of Surgery, National University Health System, National University of Singapore, Singapore.
authors.forename: Amy
authors.initials: A
authors.lastname: Tay
authors.affiliation: Department of Surgery, National University Health System, National University of Singapore, Singapore.
authors.forename: Asim
authors.initials: A
authors.lastname: Shabbir
authors.affiliation: Department of Surgery, National University Health System, National University of Singapore, Singapore; Department of Surgery, National University of Singapore, Singapore.
authors.forename: Sydney
authors.initials: S
authors.lastname: Chung
authors.affiliation: Department of Surgery, National University Health System, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Hartman
authors.affiliation: Department of Surgery, National University Health System, National University of Singapore, Singapore; Department of Surgery, National University of Singapore, Singapore. Electronic address: jimmy_so@nuhs.edu.sg.
authors.forename: Jimmy Bok-Yan
authors.initials: JB
authors.lastname: So
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D015331:Cohort Studies; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006302:Health Services Research; D006651:Histocytochemistry; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012846:Singapore; D013274:Stomach Neoplasms / Q000175:diagnosis*; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult
keywords: Early Detection; Endoscopic; Stomach Cancer; Tumor