Exploratory Analysis of Quality Indicators for Esophagogastroduodenoscopy During Surveillance Following Gastric Endoscopic Scubmucosal Dissection

OBJECTIVES: Esophagogastroduodenoscopy (EGD) is useful for early detection of gastric cancer; however, quality indicators for its performance remain unestablished. We aimed to investigate the candidate quality indicators for EGDs conducted in patients undergoing surveillance following endoscopic submucosal dissection (ESD) for gastric neoplasms. METHODS: This study is a single-center, retrospective, observational analysis. We analyzed data from post-ESD surveillance EGDs between April 2015 and March 2022. The data were divided into Periods A (April 2015-March 2017) and B (April 2017-March 2022). From Period A, we calculated each endoscopist's gastric biopsy rate (gBR), gastric positive biopsy rate (gPBR), and mean examination time as potential quality indicators for EGD performance. In Period B, we calculated the gastric neoplasm detection rate, encompassing cancer and adenoma, as the primary outcome measure. We analyzed the associations between endoscopist quality indicators in Period A and clinical outcomes in Period B. RESULTS: A total of 6792 EGDs from 2552 patients, conducted by 12 endoscopists, were analyzed. A positive correlation with gastric neoplasm detection rate was observed for gBR (r = 0.621, p = 0.03), but not for the other indicators. Endoscopists with a high gBR (> 36%) had a significantly higher gastric neoplasm detection rate than those with a lower gBR (≤ 30%) (3.6% vs. 2.0%, p < 0.05). CONCLUSIONS: A higher gBR was associated with an increased gastric neoplasm detection rate in patients undergoing post-ESD surveillance. This finding suggests the potential of gBR as a quality indicator for EGD performance in this setting.