title: Risk factors of developing interval early gastric cancer after negative endoscopy.
abstract: BACKGROUND
  New or missed gastric cancer rates after negative endoscopy are high. However, the clinicopathologic characteristics of missed or interval early gastric cancer (EGC) are not well known. The aim of this study was to evaluate clinicopathologic and endoscopic characteristics of missed or interval EGC after negative endoscopy.
  
  
  METHODS
  We retrospectively analyzed 1,055 patients with EGC confirmed by endoscopic resection or surgery between June 2006 and July 2013. Referred patients with diagnosed or suspected gastric neoplasms were excluded (n = 771). Interval EGC was defined as gastric cancer diagnosed within 2 years of negative endoscopy. Clinicopathologic characteristics of patients with initially detected and interval EGC and risk factors for interval EGC were investigated.
  
  
  RESULTS
  Of 284 patients, 52 had interval EGC (18.3 %; mean age 65.4 years; average interval between diagnosis and previous endoscopy, 12.6 months). Tumors were significantly smaller (1.3 vs. 1.8 cm, P < 0.001), and the incidence of metaplasia was significantly higher (90.4 vs. 65.9 %, P < 0.001) for interval EGC than for initially detected EGC. And no symptoms (50 vs. 17.7 %, P < 0.001) were significantly associated with interval EGC. However, tumor location, differentiation, gross morphology, and Helicobacter pylori infection status did not differ significantly.
  
  
  CONCLUSIONS
  Subtle mucosal lesions with surrounding intestinal metaplasia were associated with interval EGC. Careful endoscopic screening for patients with intestinal metaplasia at short-term interval would be beneficial for decreasing interval EGC rates.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea.
authors.forename: Young Sin
authors.initials: YS
authors.lastname: Cho
authors.forename: Il-Kwun
authors.initials: IK
authors.lastname: Chung
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Yunho
authors.initials: Y
authors.lastname: Jung
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000453:epidemiology; D000368:Aged; D005260:Female; D005773:Gastroscopy / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000453:epidemiology