Setting 6-Minute Minimal Examination Time Improves the Detection of Focal Upper Gastrointestinal Tract Lesions During Endoscopy: A Multicenter Prospective Study

Ye Gao; Meng-Xi Cai; Bo Tian; Han Lin; Zhen-Yu Jiang; Xiao-Cui Yang; Lin Lu; Li Li; Li-Hong Shi; Xiao-Yu Liu; Yi-Lin Wang; Zhao-Shen Li; Lei Xin; Luo-Wei Wang

doi:10.14309/ctg.0000000000000612

Setting 6-Minute Minimal Examination Time Improves the Detection of Focal Upper Gastrointestinal Tract Lesions During Endoscopy: A Multicenter Prospective Study

Clin Transl Gastroenterol. 2023 Aug 1;14(8):e00612. doi: 10.14309/ctg.0000000000000612.

Authors

Ye Gao^{1

2}, Meng-Xi Cai^{1

2}, Bo Tian^{1

2}, Han Lin^{1

2}, Zhen-Yu Jiang³, Xiao-Cui Yang⁴, Lin Lu⁵, Li Li⁶, Li-Hong Shi⁷, Xiao-Yu Liu⁸, Yi-Lin Wang⁹, Zhao-Shen Li^{1

2}, Lei Xin^{1

2}, Luo-Wei Wang^{1

2}

Affiliations

¹ Digestive Endoscopy Center, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China.
² National Digestive Endoscopy Improvement System, Shanghai, China.
³ Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China.
⁴ Department of Gastroenterology, Ankang Central Hospital, Ankang, Shaanxi, China.
⁵ Department of Gastroenterology, Linyi People's Hospital, Linyi, Shandong, China.
⁶ Digestive Endoscopy Center, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China.
⁷ Department of Gastroenterology, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
⁸ Department of Gastroenterology, Yulin No. 2 hospital, Yulin, Shaanxi, China.
⁹ Georgetown Preparatory School, North Bethesda, MD, USA.

Abstract

Introduction: Positive correlation between examination time and neoplasm detection using esophagogastroduodenoscopy (EGD) has been described by observational studies, but the effect of setting minimal examination time still requires investigation.

Methods: This prospective, 2-stage, interventional study was conducted in 7 tertiary hospitals in China, enrolling consecutive patients undergoing intravenously sedated diagnostic EGDs. In stage I, the baseline examination time was collected without informing the endoscopists. In stage II, the minimal examination time was set for the same endoscopist according to the median examination time of normal EGDs in stage I. The primary outcome was the focal lesion detection rate (FDR), defined as the proportion of subjects with at least one focal lesion among all subjects.

Results: A total of 847 and 1,079 EGDs performed by 21 endoscopists were included in stages I and II, respectively. In stage II, the minimal examination time was set as 6 minutes, and the median time for normal EGD increased from 5.8 to 6.3 minutes ( P < 0.001). Between the 2 stages, the FDR was significantly improved (33.6% vs 39.3%, P = 0.011), and the effect of the intervention was significant (odds ratio, 1.25; 95% confidence interval, 1.03-1.52; P = 0.022) even after adjusting for subjects' age, smoking status, endoscopists' baseline examination time, and working experience. The detection rate of high-risk lesions (neoplastic lesions and advanced atrophic gastritis) was also significantly higher in stage II (3.3% vs 5.4%, P = 0.029). In the endoscopist-level analysis, all practitioners reached a median examination time of 6 minutes, and the coefficients of variation of FDR (36.9%-26.2%) and examination time (19.6%-6.9%) decreased in stage II.

Discussion: Setting a 6-minute minimal examination time significantly improved the detection of focal lesions during EGDs and has the potential to be implemented for quality improvement.

Trial registration: ClinicalTrials.gov NCT04602299.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

China
Endoscopy, Gastrointestinal*
Humans
Prospective Studies
Tertiary Care Centers
Upper Gastrointestinal Tract*

Associated data

ClinicalTrials.gov/NCT04602299