Trial reportBMC gastroenterology2026
Routine magnifying endoscopy mode improved the diagnostic efficacy of opportunistic screening for early upper gastrointestinal neoplasms: a prospective, randomized controlled study.
Trial report in BMC gastroenterology, 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
objectiveWhite light endoscopy (WLE) is an important method for upper gastrointestinal cancer screening. However, studies have demonstrated that magnifying endoscopy with image-enhanced endoscopy (ME-IEE) achieves a significantly higher detection rate of early cancer compared with WLE. Current research has primarily focused on evaluating the diagnostic performance of ME-IEE, while evidence regarding its feasibility as a routine opportunistic screening mode for early upper gastrointestinal cancer in daily clinical practice remains limited.
methodsA prospective, single-center, randomized controlled trial was conducted between October 15, 2023, and October 7, 2024. Patients aged ≥ 18 years who underwent painless anesthesia esophagogastroduodenoscopy(EGD) at our endoscopy center were enrolled. Recruited patients were randomly assigned to either the routine magnifying endoscopy group (r-ME group) or the white light endoscopy group (WLE group). All suspicious lesions were biopsied. The primary endpoint was the detection rate of early neoplasms; secondary endpoints included biopsy implementation rate, biopsy positivity rate, mean screening time, and mean number of biopsies.
resultsA total of 3,000 patients were randomized (1:1). The detection rate of early neoplasms and biopsy positivity rate were significantly higher in the r-ME group than the WLE group (3.87% vs. 2.27% and 6.34% vs. 3.58%, respectively; both P < 0.05). However, the mean screening time was slightly longer in the r-ME group, by less than a minute (643s vs. 600s, P < 0.05). Among expert endoscopists, the detection rate of early neoplasms was significantly higher than that of non-expert endoscopists (4.54% vs. 2.50%, P < 0.05), while the biopsy submission rate was significantly lower (56.5% vs. 64.4%, P < 0.05). For non-expert endoscopists, both the detection rate of early neoplasms and biopsy positivity rate were significantly higher in the r-ME group than in the WLE group (3.32% vs. 1.67% and 5.29% vs. 2.53%, respectively; both P < 0.05). In contrast, no significant differences were observed of the above endpoints between the two groups for expert endoscopists (5.28% vs. 3.81% and 9.36% vs. 6.72%, both P > 0.05). The detection rate of early cancer using WLE mode was significantly lower for non-expert endoscopists compared with expert endoscopists (1.67% vs. 3.81%, P < 0.05). Notably, when r-ME mode was used, the detection rate achieved by non-expert endoscopists did not differ significantly from that of expert endoscopists (3.32% vs. 5.28%, P > 0.05), nor from that of expert endoscopists using WLE mode (3.32% vs. 3.81%, P > 0.05).
conclusionThe r-ME model enhances diagnostic accuracy and consistency in opportunistic screening for early upper gastrointestinal cancer, offering particular value for non-expert endoscopists.
trial registrationThis study was registered in the Chinese Clinical Trial Registry on 03/10/2023 (clinical trial registration number: ChiCTR2300076327).
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