title: The impact of pre-resection endoscopic examination time on the rate of synchronous gastric neoplasms missed during endoscopic treatment.
abstract: OBJECTIVE
  Synchronous multiple gastric cancers have been reported in up to 14% of patients, but few efforts have been made to optimize techniques for detection of multiple neoplasms. We sought to evaluate whether the length of endoscopic examination before endoscopic resection affected the detection rates of synchronous gastric neoplasms.
  
  
  METHODS
  Among patients referred for endoscopic treatment of gastric neoplasms (n = 1,017), we enrolled those in whom at least one other synchronous neoplasm was found during pre-resection endoscopy or during the 1-year follow-up examination. Pre-resection endoscopic examination time was compared between those in whom multiple neoplasms were completely diagnosed before resection (complete examination group) and those in whom multiple neoplasms were not fully diagnosed prior to resection but were found during follow-up evaluation (incomplete examination group).
  
  
  RESULTS
  Eighty-three patients were included in the study. We found no significant difference in any of the multiplicity, location, gross appearance, size, or resection type of primary lesion between the complete (n  =  46) and incomplete examination (n  = 37) groups. The complete examination group had a significantly longer examination time compared to the incomplete examination group (6.5 ± 2.4 min vs. 3.8 ± 1.8 min, respectively; P < 0.001). The synchronous lesions most commonly presented as the flat type (42/94 lesions, 45%) and were smaller than the primary lesions (10.0 ± 7.4 mm vs. 14.3 ± 9.1 mm, respectively; P = 0.002).
  
  
  CONCLUSIONS
  Endoscopists should consider the possibility of synchronous gastric neoplasms and examine the whole stomach, thus allowing adequate time to reduce the risk of missed lesions.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea.
authors.forename: Han Hee
authors.initials: HH
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea. parkjerry@catholic.ac.kr.
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea.
authors.forename: Chul-Hyun
authors.initials: CH
authors.lastname: Lim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea.
authors.forename: Jin Su
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea.
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea.
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
mesh_terms: D000368:Aged; D003951:Diagnostic Errors; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology*; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000473:pathology*; D013997:Time Factors
keywords: Endoscopic resection; Endoscopy; Gastric neoplasms; Missed lesion; Neoplasms; Synchronous neoplasia