ArticleSurgical endoscopy2026
Risk factors for missed early gastric cancer: a retrospective cohort study based on pathologically confirmed cases after endoscopic submucosal dissection.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundA 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).
methodsA 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.
resultsThe 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).
conclusionMEGC 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.
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