Risk factors for missed early gastric cancer: a retrospective cohort study based on pathologically confirmed cases after endoscopic submucosal dissection.

[BACKGROUND] A relatively high rate of early gastric cancer is missed during esophagogastroduodenoscopy (EGD). This study aimed to identify the risk factors associated with missed early gastric cancer (MEGC).

[METHODS] A retrospective study was conducted on 763 pathologically confirmed early gastric cancer lesions. Patients were categorized as initially detected early gastric cancer (IDEGC; no EGD in the previous 6-36 months) or MEGC (≥ 1 negative EGD in that interval). Independent risk factors for MEGC were identified through multivariable analysis.

[RESULTS] The MEGC rate was 22.0% (168/763). Independent risk factors were male sex (OR = 1.849) and endoscopists' age ≥ 45 years (OR = 2.737). Protective factors were lesion size ≥ 12 mm (OR = 0.616), sedation (OR = 0.376), observation time ≥ 5 min (OR = 0.625), and image-enhanced endoscopy (IEE) technology application (OR = 0.316). MEGC causes were categorized into exposure errors (35.1%), perceptual errors (34.5%), sampling errors (29.2%), and inadequate preparation (1.2%). Errors types correlated with lesion locations. 50.6% of MEGC cases were deemed potentially avoidable. A higher annual endoscopist EGD volume was inversely correlated with the technically attributable MEGC rate (r = -0.495).

[CONCLUSION] MEGC risk may be reduced through targeted interventions for high-risk populations (male), optimized endoscopic examination protocols (ensuring adequate observation time, applying sedation and IEE technology), and enhanced training in advanced technologies for older endoscopists.