The Analysis Of Repeat Endoscopy And Gastric Cancer Missed By Endoscopy

Background:Gastric cancer is a common malignancy in the world, and the top row in the reasons of death that caused by caner. In 2008, among the global new cancer patients, the incidence of gastric cancer in men ranked fourth, ranked sixth in women.In 2009, the gastric cancer incidence in our country is about 36.21/100000, stomach cancer mortality rate is about 25.88/100000, ranked third in the malignant tumor mortality. In order to reduce the mortality of gastric cancer, and reduce the burden of gastric cancer to society, the most effective measure is the surveillance in high-risk groups.In linqu of Shandong province, where has a high incidence of gastric cancer.An agency began to study the follow-up work of gastric cancer since 1995, the morbidity and mortality of gastric cancer appeared declined significantly in a dozen years. Because of the high specificity and high sensitivity of gastric cancer, endoscopy has much more advantages than other inspection methods, that is used as a preferred method of gastric cancer in the surveillance in high-risk groups by Japan n South Korea and other countries. But gastroscopy also can miss gastric cancer.The experience of operators, the time of operation duration, the number of biopsy and many other factors can influence the diagnosis of gastric cancer.In a study, nearly a third of gastric cancer diagnosis can be found in the initial inspection through the endoscopic images that were abnormal, if the patients were under repeat endoscopy, the miss of cancer can be completely avoided. In conclusion the surveillance by endoscopy can prevent gastric cancer, detect the gastric cancer in an early period, and reduce the missed rate of diagnosis.Objective:The western countries and some Southeast Asia countries like Japan, South Korea, Singapore have many literature reports on the surveillance in high-risk groups and the accuracy of endoscopy. But little has been reported in China and those reports have many shortcomings. So we collect more patients and their information as far as possible and did this study, hope to find out the situation of our own country and give some advices to the strategy of surveillance in high-risk groupsMethods:Firstly, we find out the possible risk factors by reading literatures, and sorting data of patients who meet the standards. Then we can result in the number of each risk factor、 the proportion of each factor and their situation of surveillance. By reference the definition of missed cancer, we pick out and classifiy the patients who meet the definition into 2 groups, get their information of the situation of the cancer、the number of biopsy block、the type of cancer、the gastric lesions in the first time and so on. Analysis about the missed cancer in young people, we refer to foreign literature to find out the division standard about the youth, then summarize the factors such as gender、 age、situation of the cancer、the number of biopsy blocks、the type of cancer、the gastric lesions in the first time and so on in the two groups. At last, summarize the results through statistical methods.Results:In conclusion, we review the data of 20848 patients who have had endoscopy several times and divide them into different groups by different standard after filtering. We find that in the first time of surveillance, among the 12 kinds of risk factors (excluding "the other disease"),the highest incidence of a disease is helicobacter pylori positive, the lowest is "the gastric ulcer and postoperative," and "atrophic gastritis and intestinal metaplasia after the operation " (both of them have only 1 case) The highest incidence of cancer is "ulcers with atypical hyperplasia", the lowest is "elicobacter pylori infection". And the best follow-up patient is "chronic atrophic gastritis with intestinal metaplasia and ulcer and atypical hyperplasia", the worst is "chronic atrophic gastritis with intestinal metaplasia and postoperative". We counted the progress of the disease and concluded that the three conditions such as" intestinal metaplasia appeared in the process of atrophic gastritis follow-up", " delayed-ulcer ", "anastomotic inflammation or anastomotic ulcer after gastrectomy " is the early warning factor for gastric cancer (p< 0.01).When analysis he misdiagnosis of stomach cancer,we found that the missed rate almost occurs in older men, the most common region is the lower part of the stomach, the most common type of gastric cancer is the low differentiated adenocarcinoma. Inadequate preparation before gastroscopy often lead to food and mucus retention. The operator often are lack of experience, most of the pathological examination that lead to missed caners is mucosal inflammation. The meaningful factor are "Inadequate preparation before gastroscopy" and "Inadequate biopsy" The incidence of missed cancers is similar between the youth and the elder, and the trend of follow-up compliance is worse, so we should pay more attention to the youth and strengthen follow-up education who are at the high risk of gastric cancer...